THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 
MRS.  PRUDENCE  W.  KOFOID 


PNEUMONIA: 


ITS  SUPPOSED  CONNECTION, 


PATHOLOGICAL   AND   ETIOLOGICAL, 


WITH 


AUTUMNAL   FEVEES; 


INCLUDING 


AN  INQUIRY  INTO  THE  EXISTENCE  AND  MORBID  AGENCY 


MALARIA 


BY 


R.  LA  ROCHE,  M.  D., 


MEMBER  OF  THE  AMERICAN  PHILOSOPHICAL  SOCIETY;  OP  THE  AMERICAN  MEDICAL  ASSOCIATION; 

FELLOW  OF  THE  COLLEGE  OF  PHYSICIANS  OF  PHILADELPHIA  ;    CORRESPONDING  MEMBER 

OF    THE    IMPERIAL    ACADEMY    OF   MEDICINE,    AND    FOREIGN   ASSOCIATE    OF    THE 

MEDICAL    SOCIETY    OF   EMULATION,    OF    PARIS  J    OF    THE    ACADEMIES    OF 

SCIENCES  OF  TURIN,  COPENHAGEN,  STOCKHOLM,  AND  NANCY;    OF 

THE    MEDICAL    SOCIETIES    OF    MARSEILLES,    LYONS, 

ETC.,  ETC. 


PHILADELPHIA: 
BLANC  HARD     AND     LEA. 

1854. 


Entered  according  to  the  Act  of  Congress,  in  the  year  1854,  by 
BLANCHARD  AND  LEA, 

in  the  Office  of  the  Clerk  of  the  District  Court  of  the  United  States  in  and  for  the 
Eastern  District  of  Pennsylvania. 


PHILADELPHIA: 

T.  K.  AND  T.  G.  COLLINS,  PRINTERS. 


TO  CHARLES  D.  MEIGS,  M.D. 

DEAK  DOCTOR  : — 

To  no  one  more  appropriately  than  to  yourself  can  I  dedi 
cate  this  volume.  The  innumerable  marks  of  friendly,  and  indeed 
affectionate  regard,  I  have  received  at  your  hands,  and  the  devoted 
professional  care  you  have  taken  of  me  and  mine,  by  day  and  by 
night,  during  a  period  extending  over  more  than  a  quarter  of  a 
century,  and  amid  many  painful  trials  through  which  a  kind  Provi 
dence  has  enabled  me  to  pass,  entitle  you  to  this  trifling  return. 
May  I  trust  you  will  receive  it  as  a  token  of  the  sincere  affection 
I  entertain  for  you  ?  Greatly  do  I  wish  I  could  know,  or  even 
think,  that  the  volume  which  I  here  place  before  you  were  fully 
worthy  of  your  acceptance.  Before  one  line  of  it  was  prepared  for 
publication  in  its  present  form,  I  had  decided,  as  by  the  result  of 
an  instinctive  impulse,  to  enhance  its  value  by  placing  your  honoured 
name  at  its  head;  and  no  one  who  can  appreciate  the  feeling  which 
prompted  me,  will  needs  be  told  that  I  have  striven  on  that  account 
to  render  the  book  what  it  ought  to  be.  The  effort  may  possibly — 
I.  fear  will  certainly — be  thought  by  intelligent  medical  readers  to 
have  proved  abortive.  The  results  of  my  thoughts  and  researches, 
of  my  serious  reflections  and  careful  observations,  may  perhaps  fail 
to  meet  the  expectations  of  even  the  few  indulgent  professional 
friends  who  were  apprised  of  my  intention  to  appear  before  the 
public  in  this,  to  me,  new  capacity.  But,  should  my  volume  meet 
the  fate  which  many  like  it  have  suffered,  and  many  more  deserve 
to  suffer,  at  the  hands  of  the  tribunal  to  whose  decision  all  produc 
tions  of  the  kind  must  be  submitted — should  it  be  soon  consigned 
to  oblivion — I  shall  feel  neither  disappointment  nor  regret,  provided 
I  can  be  certain  that  you  have  received  some  gratification  at  my 
having  selected  you  as  its  sponsor.  Would  it  could  prove  the 
worthy  rival  of  the  great,  and  unfortunately  unfinished  work  of 


iv  LETTER  TO   CHARLES   D.   MEIGS. 

our  common  illustrious  friend,  the  late  Dr.  Drake,  whose  loss  we 
cannot  cease  to  deplore,  and  of  whose  reputation  every  member  of 
our  profession  in  this  country  must  be  proud.  But  this  I  could  no 
more  hope  than  you  could  expect ;  and  I  must  be  satisfied  if  my 
unpretending  production  can  be  read  by  you,  and  other  medical 
men  whose  opinions  are  entitled  to  confidence,  with  some  mani 
festation  of  approbation. 

It  cannot  but  be  a  matter  of  astonishment  to  you,  who  know 
something  of  my  tastes  and  habits,  and  of  the  tardiness  and  even 
reluctance  I  have  heretofore  shown  in  preparing  for  publication 
materials  long  ago  collected  and  arranged  on  a  favourite  and  im 
portant  subject,  that  I  should  so  unexpectedly  alter  my  course,  and 
place  before  the  public  a  work  treating  of  a  topic  on  which,  two 
years  ago,  I  had  no  more  intention  of  writing  than  I  have  now  of 
composing  a  practical  treatise  on  your  specialty.  But  so  it  is — 
Uhomme  propose,  et  Dieu  dispose.  Here  I  am  laying  aside  the  results 
of  a  labour  of  years,  and  troubling  that  very  same  public  with  a 
work  of  questionable  interest  on  a  subject  only  indirectly  connected 
with  that  of  my  former  researches.  A  fc\v  words  in  explanation 
of  my  reasons  for  so  acting  may  not  be  out  of  place. 

The  present  volume,  like  some  better  ones,  has  grown  to  its 
actual  respectable  dimensions  from  very  small  beginnings.  The 
first  step  in  its  production  was  the  writing  of  a  friendly  letter  of  a 
dozen  pages,  to  a  most  valued  friend,  who  holds  an  important  posi 
tion  among  the  physicians  and  teachers  of  a  distant  State,  in  review 
of  a  clever  essay  by  him,  on  Pneumonia.  In  the  course  of  a  cor 
respondence  which  ensued  on  the  subject,  I  prepared  and  for 
warded  another  and  much  longer  letter,  in  which  some  of  the  views 
set  forth  by  him  were  critically  examined.  Soon  after,  those  com 
munications  were,  at  the  suggestion  of  several  friends,  converted  into 
Essays,  and  published  in  successive  issues  of  the  Charleston  Medical 
Journal.  There  they  attracted  the  attention  of  some  physicians, 
whose  views  on  the  various  topics  treated  of  coincide  with  mine, 
and  were  noticed  with  commendation  in  a  few  medical  periodicals. 
From  various  quarters,  I  received  the  advice  to  publish  them  in  a  col 
lected  and  more  permanent  form.  I  shall  not  stop  to  inquire  whether 
this  advice  was  impartial,  or  whether  it  was  not  rather  founded  on 
an  unmerited  estimate  of  the  importance  of  the  Essays,  resulting 
from  the  disturbing  influence  which  personal  attachment  is  so  apt 
to  create  under  circumstances  of  the  kind ;  for  on  a  question  con- 


LETTER  TO   CHARLES   D.   MEIGS.  V 

cerning  the  value  of  my  own  production,  I  leave  the  decision  to 
others.  But,  however  this  may  be,  after  some  hesitation,  I  yielded, 
perhaps  unwisely,  to  that  advice,  and  lost  no  time  in  preparing  the 
whole  for  the  press — cutting  out,  adding,  rearranging,  and  often 
rewriting.  I  am  not  sure  that  by  these  changes  I  have  improved 
the  original  publication.  On  that  score,  indeed,  I  have  had  mis 
givings,  and  at  times  entertained  serious  thoughts  of  consigning  the 
whole  to  the  flames.  But  again  I  submitted  to  the  decision  of  those 
in  whose  judgment  I  repose  confidence.  Encouraged  by  their  opin 
ion,  I  dare  hope  that  if,  by  acting  as  I  have  done,  no  improvement 
in  the  original  text  has  been  effected,  I  shall,  at  least,  not  be  taxed 
with  having  augmented  the  many  blemishes  it  already  contained. 

"While  entertaining  this  hope,  I  cannot  help  fearing  that  my  pro 
fessional  readers,  and  yourself  among  them,  will  disapprove  of  the 
result  of  my  labours,  when  it  is  perceived  that,  instead  of  curtailing 
the  many  redundances,  omitting  the  facts  of  doubtful  importance, 
abridging  the  lengthy  statements,  and  expunging  a  large  amount  of 
the  references  embodied  in  the  original  publication,  I  have  added 
fresh  materials  to  the  stock.  Not  less  do  I  fear  that  I  shall  be 
censured  for  not  having  taken  adequate  pains  to  elaborate  the 
whole,  to  class  properly  and  clearly  the  various  topics  examined,  to 
avoid  enlarging  unduly  on  some  points,  and  slurring  over  others, 
as  well  as  to  correct  and  polish  the  language. 

But  although  ready  to  admit  that  in  these  matters  the  volume  is 
amenable  to  the  censure  of  tasteful  readers,  and  fairly  exposed  to 
the  lash  of  the  critic,  I  cannot  but  think  that  those  who  honour  me 
with  an  attentive  perusal,  will  abate  somewhat  of  the  severity  of 
this  judgment,  when  they  reflect  that  the  main  object  of  the  work 
was,  not  to  produce  an  elegant  and  finished  composition,  but  to 
point  out  the  erroneousness  of  views  entertained  by  respectable 
writers  on  certain  pathological  and  etiological  subjects;  that  this 
could  not  be  more  successfully  done  than  by  accumulating  as  many 
facts  as  possible,  with  a  view  to  sustain  each  limb  of  the  argu 
ment;  and  that,  in  order  to  impress  on  the  mind  of  the  inquirer  an 
idea  of  the  appositeness  and  authenticity  of  those  facts,  and  to 
enable  him  to  verify  their  accuracy,  it  would  be  advantageous  to 
give  them  mostly  in  the  language  of  their  reporters,  and  to  state 
exactly  where  the  records  of  theni  were  to  be  found. 

In  reference  to  the  want  of  artistic  skill  displayed  throughout 
the  entire  volume,  I  can  only  express  my  regret.  No  one  is  more 


vi  LETTER  TO   CHARLES  D.   MEIGS. 

aware  of  the  defect  than  myself.  Nor  shall  I  deny  that  the  charge 
respecting  the  absence  of  a  proper  classification,  and  the  dispropor-  . 
tionate  extent  allotted  to  some  of  the  subjects  treated  of,  at  the  ex 
pense  of  others,  is  well  founded.  I  feel  especially  that  I  might, 
without  detriment,  have  disconnected  the  long  inquiry  relative  to 
the  existence  and  morbific  agency  of  malaria  in  the  production  of 
autumnal  fevers  from  the  rest  of  the  work,  have  given  it  a  separate 
and  independent  form,  and  published  it  apart ;  or,  what  would  per 
haps  have  been  still  better,  omitted  it  altogether;  and,  taking  for 
granted — what  is  not  far  from  the  truth — that  nearly  every  one 
admits  the  existence  and  agency  of  a  febrile  poison,  have  proceeded 
in  the  argument  without  troubling  myself  with  the  denials  of  a  few 
opponents.  Such  might,  perhaps,  have  been  my  course,  but  I 
thought  otherwise  at  the  time;  and,  indeed,  think  so  still.  In  order 
to  sustain  the  position  I  had  assumed,  it  was  necessary  to  show 
that  pneumonia,  which  some  writers  regard  as  a  mere  form  of 
autumnal  fevers,  arises  from  causes  distinct  from  those  to  which  the 
latter  diseases  are  due ;  and  it  appeared  to  me  that  this  could  not 
be  better  done  than  by  first  inquiring  what  those  causes  really 
were,  and  then  showing  that,  while  pulmonary  inflammation  is  pro 
duced  by  a  certain  set  of  agencies,  the  fevers  in  question  are  the 
offspring  of  a  specific  gaseous  poison.  But,  at  the  same  time,  it 
occurred  to  me  that,  as  some  of  the  advocates  of  the  identity  of 
those  diseases  disbelieved  the  existence  and  ignored  the  agency  of 
this  poison,  my  task  would  be  unfinished  were  I  not  to  demon 
strate  their  errors  on  this  point.  Influenced  by  these  views,  I  set 
to  work ;  facts,  and  what  I  may,  perhaps  wrongfully,  consider  argu* 
ments,  accumulated  under  my  pen,  and  the  result  has  been  the 
strange  compound  I  to-day  lay  before  you,  and  for  the  many  im 
perfections  of  which  I  solicit  your  kind  indulgence. 

I  need  not  tell  you — for  you  will  easily  perceive  on  casting 
your  eyes  over  the  following  pages  —  that  I  have  not  aimed 
at  offering  anything  new ;  that  it  has  not  been  my  object  to 
start  a  new  theory  or  hypothesis,  and  to  establish  it  on  grounds, 
and  by  facts,  heretofore  unknown,  and  by  the  help  of  arguments 
equally  unheard  of.  So.  far  from  this,  I  have  no  hesitation  in 
stating  that  the  idea  of  claiming  credit  for  originality  has  never 
entered  my  mind.  All  the  credit  to  which  I  think  myself  entitled 
—if  any  can  be  legitimately  considered  due  lo  me — is  for  having 
collected,  within  a  comparatively  small  compass,  the  main  facts 


LETTER  TO   CHARLES   D.   MEIGS.  vii 

bearing  on  the  question  at  issue,  derived  from  reliable  sources  in 
various  sections  of  the  globe,  and  from  the  results  of  my  own  per 
sonal  observation  ;  for  having  examined,  to  the  best  of  my  ability, 
the  subject  in  all  its  bearings;  for  having  demonstrated,  in  as  for 
cible  a  way  as  I  have  been  able,  that  the  idea  of  the  identity  under 
consideration  is  founded  on  insufficient  and  incorrect  data,  and  is* 
in  fact,  little  more  than  a  dream  of  the  imagination;  and,  at  the 
same  time,  for  having  proved  that  etiologists  who  regard  the  various 
forms  of  autumnal  fevers  as  due  to  the  action  of  particular  poisons 
floating  in  the  atmosphere  of  specific  localities,  have  just  cause  for 
entertaining  that  belief.  This,  I  repeat,  is  all  I  have  attempted  to 
perform. 

Nature  has,  I  think,  given  me  a  decided  taste  for  certain  inves 
tigations — a  large  share  of  power  of  application — some  degree*  of 
aptness,  as  I  have  been  told,  to  observe  and  reason  correctly.  At 
the  same  time,  circumstances  have  often  been  such  as  to  allow  me 
leisure  to  indulge  my  inclination  for  research;  while,  during  the 
third  part  of  a  century  that  I  have  been  attached  to  the  medical 
profession,  my  opportunities  for  observation  have  neither  been  few 
nor  neglected.  But  to  originality  of  thought,  or  the  ability  to  make 
striking  discoveries,  I  can  lay  no  claim.  Indeed,  were  I  so  gifted, 
I  am  not  sure  that  I  should  not  endeavour  to  restrain  the  exercise 
of  these  powers,  for  fear  of  entering  into  the  boundless  field  of  hy 
pothesis.  On  this  subject  my  mind  has  long  been  made  up;  and 
from  all  I  have  seen,  I  can  entertain  no  doubt,  that  more  good  is 
to  be  effected  by  a  patient  accumulation  and  comparison  of  im 
portant  facts,  and  by  endeavouring  to  draw  from  the  whole  correct 
philosophical  deductions,  than  by  adopting  a  different  course,  too 
common  among  the  professional  writers  of  this  country  and  else 
where  ;  who,  discarding  the  results  of  the  experience  of  former 
and  present  times,  and  relying  exclusively  on  their  own  too  often 
scanty  observations,  make  up  for  their  other  deficiencies  by  an 
indulgence  in :  theoretical  explanations ;  and  sneer  at  the  patient, 
slow,  and  cautious  observer,  and  the  erudite  student.  That  the 
tendency  to  the  course  here  adverted  to  is  displayed  by  a  goodly 
number  of  physicians  among  us  is,  as  you  know  full  well,  too  true  to 
be  denied.  It,.has  long  been  to  me,  and  to  others  on  whose  natural 
good  sense,  souud.iudgment,  and  medical  scholarship  we  may  rely, 
a  source  of  deep  solicitude ;  threatening,  as  it  does,  if  allowed  to 
continue  unchecked,  to  affect  injuriously  our  literary  and  scientific 


Vlll  LETTER  TO   CHARLES   D.   MEIGS. 

character,  and  to  retard  the  advancement  of  useful  professional 
knowledge  among  us.  The  picture  I  have  drawn  is  not  exaggerated ; 
and  the  history  of  medicine  clearly  shows  that  those  who  have  im 
proved  the  scientific  and  practical  department  of  our  art,  have,  with 
few  exceptions,  been  men,  not  of  lively  imagination  and  inventive 
powers  of  mind,  but  careful  and  industrious  observers;  men  of 
sound  judgment,  and  of  well-read  and  cultivated  minds. 

Indeed,  this  subject  is  so  important  and  interesting,  that  I  trust 
it  will  justify  my  taking  this  opportunity  to  offer  a  few  remarks  on 
some  of  the  leading  circumstances  which  have  exercised  an  injurious 
influence  on  medical  literature  and  professional  knowledge  in  this 
country,  and  which  it  ought  to  be  the  aim  of  every  true  votary  of 
our  art  to  modify  and  remove. 

Compared  with  that  of  Europe,  whether  of  Germany,  France, 
England,  or  even  Italy,  the  medical  literature  of  the  United 
States  may  be  said  to  be  as  yet  in  a  state  of  infancy.  This  is  true 
both  as  regards  the  number  of  original  publications  which  issue 
from  the  press,  and  their  practical  importance,  scientific  character, 
or  literary  merit.  It  would  be  unnecessary,  and  out  of  place,  to 
dwell  here  on  the  causes  which  have  contributed  to  produce  this 
result;  but,  be  they  what  they  may,  that  result  is  placed  beyond 
the  possibility  of  doubt;  for  no  professional  reader  can  have  failed 
to  perceive  that,  although  original  treatises,  monographs,  and  elabo 
rate  essays  on  various  branches  of  medical  science,  have  appeared 
on  this  side  of  the  Atlantic,  their  number  is  comparatively  limited; 
and  it  is  a  fact  which  no  one  here  will  venture  to  deny  that,  while 
some  of  these  would  do  honour  to  any  country,  the  greater  number 
are  not  of  such  a  character  as  to  entitle  them  to  general  commenda 
tion  and  lasting  attention.  Not  less  readily  will  it  be  admitted,  by 
those  who  take  an  expansive  survey  of  the  minor  medical  produc 
tions  of  this  country,  such  as  original  essays  of  small  size,  either 
issued  in  a  separate  form,  or  as  contributions  to  periodical  journals, 
that,  although  more  numerous  than  the  former  class,  they  seldom 
add  anything  to  the  character  of  our  professional  literature,  and  ex 
hibit  even  less  merit,  both  in  reference  to  the  matter  they  contain, 
and  the  manner  in  which  they  are  written,  than  might  have  been 
anticipated  when  we  consider  the  multitude  of  physicians  scat 
tered  over  the  vast  extent  of  this  country,  the  unlimited  opportu 
nities  for  collecting  observations  of  interest  and  value  within  their 
reach,  as  well  as  the  sound  sense  and  the  capacity  for  practical  and 


LETTER  TO    CHARLES   D.   MEIGS.  ix 

scientific  investigation  which  form  attributes  of  the  American  mind. 
With  these  facts  before  him,  every  American  physician  who  is  alive 
to  the  honour,  dignity,  and  interest  of  his  profession,  will  unite  in 
the  opinion  that  we  have,  so  far  as  medical  literature  is  concerned, 
a  character,  not  to  uphold  merely,  but  to  establish;  and  that  conse 
quently  it  behooves  him,  while  neglecting  no  means  to  improve 
himself  in  the  various  branches  of  medical  science,  to  shun  care 
fully,  and  to  reprove  in  others,  every  practice  which  may,  in  any 
degree,  retard  the  accomplishment  of  so  desirable  an  end. 

It  would  be  impossible,  in  the  space  allowed  me  on  this  occasion, 
to  point  out  in  detail  the  several  baneful  influences  here  alluded  to ; 
let  it  suffice  to  dwell  on  two  of  the  more  prominent.  It  is  not  un 
common  to  find  inexperienced  medical  writers  in  this  country — as, 
indeed,  elsewhere — hazarding,  on  physiological,  pathological,  etio- 
logical,  or  practical  subjects,  opinions  completely  at  variance  with 
those  which  the  enlightened  portion  of  medical  men,  throughout 
the  civilized  world,  regard  as  placed  Beyond  the  reach  of  cavil  or 
disputation,  or,  at  least,  as  entitled  to  the  most  respectful  considera 
tion.  Some,  in  their  dissent  from  the  current  opinion  of  the  medi 
cal  world,  content  themselves  with  throwing  out  a  simple  conjecture, 
or  perchance  pronouncing  a  positive  statement.  Others,  more  am 
bitious,  bring  forward  a  complex  theory,  or  do  not  hesitate  to  enter 
upon  systematic  developments.  Nor  is  it  less  common  to  find  these 
scientific  aspirants  upholding  their  novelties  by  an  ostentatious  dis 
play  of  argument,  by  an  appeal  to  collateral  illustrations,  and  by  a 
triumphant  reference  to  facts  of  a  more  or  less  apposite  character  ; 
the  whole  seasoned  with  a  confident  and  uncompromising  assertion 
of  the  legitimacy  of  their  deductions,  and  with  a  decided,  sometimes 
contemptuous,  condemnation  of  the  views  entertained  on  the  same 
subjects  by  all  preceding  or  contemporary  writers.  As  might  be 
foreseen,  such  attempts  at  innovation,  the  detailed  enumeration  of 
which  would  form  an  amusing  chapter  in  the  history  of  oar  profes 
sion,  have  so  far,  with  occasional  exceptions,  failed  to  produce  the 
effects  intended,  and  to  command  general  and  continuous  atten 
tion. 

Novel  explanations  of  known  phenomena  are  offered;  analogies 
or  differences  heretofore  unthought  of,  are  pointed  out  and  insisted 
upon ;  effects  are  ascribed  to  causes,  which  before  were  unsuspected 
of  producing  them ;  while,  on  the  other  hand,  the  agency  of  morbid 
influences,  universally  regarded  as  occasioning  certain  phenomena, 


X  LETTER  TO   CHARLES   D.   MEIGS. 

is  denied ;  remedies  are  asserted  to  possess  powers  very  different 
from  those  usually  attributed  to  them ;  superiority  of  success  is 
claimed  for  modes  of  treatment  which  experienced  practitioners 
have  been  taught  to  view  with  suspicion ;  but  all  in  vain.  The 
reader,  if  not  a  novice  in  medical  literature,  and  a  tyro  in  profes 
sional  knowledge,  is  not  slow  to  discover  the  small  degree  of  reli 
ance  which  can  be  placed  on  such  attempts  at  innovation ;  and 
finds  that  the  theories  or  hypotheses  so  pompously  and  confidently 
set*  forth,  so  far  from  being  satisfactory,  and  likely  to  answer  the 
purpose  of  their  authors,  are  generally  of  a  loose,  crude,  and  un- 
philosophical  character;  in  many  cases  evidently  the  offspring  of 
men  who  are  young  in  years  and  young  in  experience,  who  are 
richer  in  self-esteem  and  assurance  than  discretion  and  learning ; 
of  men  whose  minds  are  immature,  untrained,  and  ill  stored.  He 
finds  that  they  are  founded  on  hastily  collected  and  ill-digested 
observations,  cemented  together  by  illogical  or  overstrained  reason 
ings,  and  though  fit,  perhaps,  for  the  edification  of  young  beginners, 
are  unworthy  of  serious  consideration  on  the  part  of  men  of  mature 
age,  and  sound  and  extensive  acquirements. 

Not  unfrequently,  the  well-informed  reader  recognizes  in  the 
proposed  novelty  some  old  acquaintance,  which — after  having 
enjoyed,  at  some  bygone  time,  an  ephemeral  reputation,  had  dis 
appeared  under  the  lash  of  the  reviewer,  or  sunk  into  oblivion 
from  an  innate  want  of  vital  force — is  now  once  rnore^brought  forth, 
in  a  more  or  less  modified  garb,  to  glitter  for  a  short  moment  in  the 
eyes  of  the  unskilled,  and,  of  course,  soon  to  meet  a  fate  similar  to 
that  it  had  already  encountered.  Even  when  he  finds,  in  such 
lucubrations,  something  calculated  to  amuse  or  interest,  or  some 
times,  perchance,  to  seduco  him  momentarily  from  the  more  rational 
opinions  he  had  before  entertained,  he  in  a  brief  while  becomes 
sensible  of  his  error,  and  reverts  to  his  former  faith.  If  he  does  not 
forget  what  he  has  just  read,  he  at  least  views  it  in  the  same  light  as 
other  vagaries,  of  which  the  annals  of  medicine,  both  on  this  and  on 
the  other  side  of  the  Atlantic,  furnish  many  a  curious  example. 
With  such  facts  before  him,  he  cannot  be  regarded  as  over  fastidious 
if  he  unite  in  sentiment  with  those  who  maintain  that  the  stuff  of 
which  medical  reformers  and  leaders  in  scientific  advancement  are 
made  is  a  rare  product;  that  in  all  parts  of  the  world,  and  here,  per 
haps,  more  than  elsewhere,  readiness  and  smartness  have  but  too 
often  been  mistaken  for  strong  power  of  thought,  and  superficial  in- 


LETTER  TO   CHAELES   D.   MEIGS.  Xl 

formation  has  taken  the  place  of  sound  and  accurate  learning ;  that 
in  a  field  where  men  of  well-disciplined  and  well-stored  minds,  and 
rich  in  accurate  observation — men  who  have  within  their  reach 
the  means  of  testing  the  statements  of  other  investigators,  whose 
standing  is  equal  to  their  own — men  who  live,  as  it  were,  in  an 
atmosphere  of  science,  have  failed ;  it  is  scarcely  to  be  expected 
that  individuals  of  ordinary  capacity,  with  little  experience,  and  as 
little  reading,  who  are  unused  to  accurate  processes  of  scientific 
investigation  and  close  induction,  and  who  possibly  move  within 
localities  where  opportunities  for  prosecuting  the  requisite  researches 
on  a  sufficiently  enlarged  scale  are,  in  a  great  measure,  wanting,  will 
reap  laurels,  and  assume  a  conspicuous  place  in  the  ranks  of  medi 
cal  reformers,  <y  add  greatly  to  the  stock  of  useful  knowledge. 

The  cause  of  these  successive  and  repeated  efforts  at  revolution 
izing  the  science  in  some  or  all  of  its  parts,  of  this  reluctance  to 
pursue  the  common  track,  and  of  this  disposition  to  discard 
opinions  long  entertained,  and  to  substitute  others  of  a  contrary 
character,  need  not  be  made  here  the  subject  of  detailed  examina 
tion.  That  in  some  cases  the  result  is  due  solely,  or  in  a  great 
measure,  to  a  craving  after  notoriety — to  the  ambitious  desire  to  be 
pointed  out  by  medical  or  rather  by  unprofessional  men,  as  authors 
of  brilliant  discoveries,  and  as  gifted  agents  of  scientific  and  practi 
cal  improvements;  in  other  words,  that  the  guiding  impulse  is 
more  frequently  the  desire  for  personal  advancement  and  pecuniary 
gain,  than  a  due  regard  for  the  interest  of  science,  we  have  every 
reason  to  conclude.  Equally  true  is  it,  that  we  may  sometimes 
trace  this  result  to  the  mere  desire  of  gratifying  the  innocent  and 
harmless  vanity  to  which  some  individuals,  especially  young  medi 
cal  men,  fresh  from  the  schools,  are  keenly  alive,  that  of  seeing  their 
names  in  print;  more  particularly  if  they  can  so  appear  in  con 
nection  with  something  really  or  seemingly  new,  and  calculated  to 
attract  attention.  These  lucubrations,  though  of  no  earthly  value 
to  any  one  in  a  scientific  or  other  point  of  view,  are  to  their  pro- 
rnulgators  objects  of  vast  importance;  and  hence  the  desire  to  see 
them  spread  out  in  the  pages  of  a  medical  journal,  side  by  side 
with  the  contributions  of  older  and  better  known  physicians.  We 
may  also  suppose  that,  in  some  instances,  it  is  the  offspring  of  the 
foible  which  nature  has  infused  into  the  composition  of  some  happy 
individuals,  who  imagine  themselves  endowed  with  the  faculty  of 
unravelling  the  most  intricate  mysteries  of  the  science,  and  of 


xii  LETTER   TO   CHARLES   D.    MEIGS. 

discovering  truths  heretofore  concealed  from  the  notice  of  medical 
investigators  from  the  days  of  Hippocrates  to  the  present;  and 
who  fancy  they  can  explain  all  professional  questions,  however 
complex  and  apparently  foreign  to  their  ordinary  pursuits  or  their 
opportunities  of  inquiry,  in  a  more  lucid,  natural,  and  satisfactory 
way  than  any  of  their  predecessors  or  contemporaries. 

Such  is  the  probable  explanation  in  many  instances.  But  the 
medical  world  is  occasionally  startled  by  the  appearance  of  hypotheses 
and  theories,  both  crude  and  untenable,  and  sometimes  of  more 
than  problematical  originality,  by  a  very  different  class  of  men. 
The  hypotheses  to  which  allusion  is  here  made  are  promulgated 
with  unflinching  confidence  by  individuals  to  whom,  from  the 
distinguished  position  they  have  reached  in  the  racks  of  the  pro 
fession,  from  the  respectable  character  of  their  intellectual  endow 
ments,  from  the  extent  of  their  general  and  medical  acquirements, 
no  less  than  from  the  high  standing  of  their  moral  character,  we 
cannot  justly  attribute  selfish  considerations,  youthful  vanity,  or 
the  monomania  of  authorship ;  and  who  might  have  been  expected 
to  abstain  from  the  attempt  to  stem  the  current  of  received  opinions, 
and  to  aspire  to  the  honours  awarded  to  true  medical  reformers,  and 
correct  exponents  of  new  views.  In  these,  the  cause  must  be  sought, 
sometimes  in  the  want  of  a  proper  balance  between  the  fancy  and  the 
judgment,  a  defect  which  leads  the  individual  to  mistake  ingenious 
flights  of  the  imagination,  odd  notions,  and  whimsicalities,  for  correct 
inferences  from  enlarged  and  accurate  observations.  In  others,  it  is 
to  be  found  in  a  disposition,  not  uncommon  even  among  otherwise 
clever  men,  to  discard  received  opinions  whenever,  in  their  estima 
tions,  these  do  not  prove  satisfactory  on  all  points,  however  shadowy 
may  be  the  grounds  of  dissatisfaction,  and  to  fly  at  once  to  the  most 
opposite  modes  of  explanation. 

In  a  different  class,  we  must  seek  the  explanation  in  a  restless 
tendency,  not  unfrequently  exhibited  by  individuals  whose  minds, 
though  naturally  good  and  well  cultivated,  have,  nevertheless, 
not  been  thoroughly  trained  in  the  school  of  severe  induction,  to 
jump  hastily  at  conclusions  and  to  draw  inferences  without  having 
collected,  analyzed,  and  compared  a  sufficient  number  of  facts, 
bearing  directly  or  indirectly  on  the  point  at  issue.  Sometimes  we 
find  it  in  a  disinclination  to  examine  the  subject  in  all  its  bear 
ings;  in  a  deficiency  in  the  power  ©^appreciating  the  full  force  of 
facts  and  circumstances  militating  against  the  views  adopted,  or  a  too 


LETTER   TO    CHARLES    1).    MEIGS.  Xlll 

habitual  tendency  to  undervalue  the  authority  of  those  by  whom 
they  are  adduced.  Again,  it  is  traced  to  an  inability  to  discover  the 
connection  existing  as  cause  and  effect,  between  the  phenomena 
to  which  attention  is  called  ;  and  quite  as  frequently,  to  a  scanty 
acquaintance  with  what  has  been  already  written  on  the  subject  on 
which  the  author  proposes  to  enlighten  the  medical  public. 

It  has  been  remarked  by  competent  judges,  that  the  first  thing 
an  individual  should  attend  to,  who  undertakes  to  write  on  pro 
fessional  topics,  especially  when  he  fancies  he  has  discovered  new 
truths,  or  devised  a  theory  respecting  the  reciprocal  relations  of 
facts  already  known,  which  is  more  acceptable  than  any  anteriorly 
received,  is  to  make  himself  familiar  with  all  that  has  been  written 
on  the  subject.  "When  the  observer,"  says  Sprengle,  "  whatever  be 
the  extent  of  his  genius,  has,  nevertheless,  not  enough  of  erudition 
to  be  acquainted  with  the  observations  of  his  predecessors,  he  runs 
the  risk  of  repeating  what  has  already  been  said  a  hundred  times 
before,  and  of  publishing  it  as  his  own  discovery.  Hence,  the 
advantages  of  true  erudition."1 

Well  would  it  be  for  aspiring  reformers  and  discoverers,  abroad 
and  at  home,  were  they  to  take  heed  of  the  sage  advice  of  the 
great  historian  of  medicine.  By  enlarging  the  sphere  of  their  pro 
fessional  erudition  beyond  a  few  text  and  other  works  of  easy 
access,  or  the  numbers  of  some  periodical  journals,  they  would  pos 
sibly  be  deterred  from  laying  before  the  medical  world  the  products 
of  their  unimportant  cogitations,  and  the  results  of  their  imperfect 
observations,  seeing  that  others,  differing  but  little  from  them,  had 
been  presented — perhaps  more  forcibly  and  clearly — before,  and 
had  been  long  refuted  or  disproved,  or  passed  by  without  comment 
or  sign  of  approbation;  thus  saving  themselves  the  risk  of  disap 
pointment,  perhaps  mortification,  and  sparing  to  others  a  vast 
amount  of  useless  reading. 

Easy  as  it  may  be  to  account  for  the  manifestation  of  the  pro 
pensity  in  question  among  the  several  classes  of  physicians  just 
passed  in  review,  yet  instances  occasionally  present  themselves,  in 
which  opinions  of  an  unsatisfactory,  untenable — not  to  say  extrava 
gant  character,  often  of  more  than  doubtful  originality,  and  which, 
if  proved  to  be  well  founded,  would  overturn  all  our  previous  and 
long  established  vie.ws,  are  thrown  out,  and  boldly  and  confidently 

1  Handbook^  Pathology,  vol.  i. 


XIV  LETTER   TO    CHAKLE3   D.   MEIGS. 

asserted,  in  quarters  where  none  of  the  explanatory  reasons  above 
enumerated  would  seem  to  apply. 

These  opinions  originate  with  individuals  in  whom  the  imagina 
tive  powers  have  always  appeared  to  be  properly  tempered  by 
sound  judgment;  who  have  not,  in  other  matters,  evinced  a  tend 
ency  to  adopt  hasty  and  far-fetched  conclusions;  whose  field  of 
observation  has  been  ample,  and  assiduously  and  profitably  culti 
vated  ;  whose  search  after  information  on  collateral  branches  of 
knowledge  has  never  been  neglected ;  and  by  whom  care  has  evi 
dently  been  taken  to  render  themselves  familiar  with  a  large  share 
of  the  writings  of  the  best  authors.  These  stand  apart  from  all 
other  innovators,  and  might  properly  be  made  here  the  subject  of 
some  remarks ;  but,  from  want  of  room,  and  the  fear  of  exhausting 
the  patience  of  the  reader,  which  has  been  already  too  heavily 
taxed,  I  must  resign  into  other  and  abler  hands  the*duty  of  clear 
ing  up  the  mystery  which  this  manifestation  of  the  tendency  of 
which  I  am  speaking  is  so  well  calculated  to  create. 

It  is  needless  to  illustrate  the  correctness  of  these  remarks  by  a 
detailed  account  of  instances  in  which  the  propensity  in  ques 
tion  has  been  indulged  to  a  greater  or  less  degree.  Cases,  in  which 
facts  and  views  long  familiar  to  well-read  physicians  have  been 
seriously  presented  as  new,  or  cases  in  which  the  strangest  vagaries 
have  been  launched  forth,  and  strenuously  maintained,  will  doubt 
less  present  themselves  to  the  mind  of  every  reader,  who  will  find 
no  difficulty  in  placing  the  authors  of  them  in  some  one  or  other  of 
the  categories  above  enumerated. 

It  is  important  that  the  aspirant  to  professional  fame,  who  places 
himself  before  the  public  in  the  capacity  of  author,  should  carefully 
avoid  every  attempt,  or  semblance  of  an  attempt,  to  pass  off  as  his 
own,  in  whole  or  in  part,  what  in  reality  belongs  to  others.  In 
other  words,  too  much  care  cannot  be  taken  by  medical  writers  to 
shield  themselves  from  the  accusation  of  plagiarism;  whether  in 
reference  to  points  of  doctrine  or  to  facts,  or  whether  it  applies  to 
the  language  in  which  the  borrowed  materials  are  conveyed.  Many 
a  reputation,  otherwise  unassailable,  has  been  greatly  stained  by  a 
single  act  of  literary  pilfering.  Such  acts  -are  of  course  dishonour 
able,  and  should,  like  every  other  illicit  appropriation,  be  shunned 
by  all  men  endowed  with  a  proper  share  of  moral  sense ;  and  unhesi 
tatingly  exposed  by  every  medical  man,  who  is  alive  to  the  honour 


LETTER  TO   CHARLES   D.   MEIGS.  XV 

and  dignity  of  his  profession,  and  who  necessarily  feels  that  the 
commission  of  such  acts  must,  if  frequently  repeated,  and  allowed 
to  pass  unnoticed,  cast  a  shade  over  the  reputation  of  the  medical 
literature  of  the  country,  and  make  it  an  object  of  derision  with 
European  writers.  Far  be  it  from  us  to  affirm  that  such  irregulari 
ties  are  not  committed  on  the  other  side  of  the  Atlantic.  Were 
this  the  proper  place,  many  and  curious  cases  in  point  might  be 
collected  from  the  productions  of  the  English  and  French  medical 
press.  But  on  these  we  need  not  dwell.  It  is  sufficient  for  us  to 
guard  our  own  reputation.  Depredations  of  this  sort  in  Europe  can 
prove  no  valid  excuse  for  their  commission  on  this  side  of  the  At 
lantic.  Let  European  writers  steal  from  each  other,  and  from  us,  if 
they  think  fit.  The  theft  will  disgrace  the  culprit,  but  in  no  way 
reflect  injuriously  on  the  medical  literature  of  the  country  at  large ; 
which  is  too  rich,  in  original  works  of  merit  to  be  seriously  affected  by 
a  few  transgressions  of  this  sort.  But,  in  the  name  of  all  that  is  manly 
and  honourable,  let  us  not  lay  ourselves  open  to  such  accusations. 
"We  may  doubtless  congratulate  ourselves  that  thus  far  acts  of  de 
cided  plagiarism  have  not  been  exceedingly  numerous  among  us. 
Yet,  while  doing  so,  it  cannot  be  concealed  that  several  have  already 
been  committed;  that  some  occasionally  come  to  light,  and  that  a 
few  of  those  detected  are  of  a  barefaced  and  even  monstrous  charac 
ter,  and  have  proceeded  from  quarters  where  they  might  have  been 
least  expected  to  originate.  Let  us  hope  that  such  transgressions 
will  not  be  repeated,  and  that,  if  repeated,  their  authors  will  be  ex 
posed  and  consigned  to  the  contempt  of  their  professional  brethren. 
Too  much  care  cannot  be  taken  to  put  a  stop  to  such  proceedings; 
for  their  effect  on  the  reputation  of  our  infant  medical  literature 
must  necessarily  be  of  the  most  baneful  character.  If  the  physi 
cians  of  this  country  frequently  steal  from  European  writers,  or  from 
each  other,  all  confidence  in  their  integrity  will  be  lost.  He  who 
can  attempt  to  deceive  in  respect  to  his  claims  to  authorship ;  he 
who  can  stoop  to  the  disgraceful  act  of  purloining  the  thoughts  of 
his  brethren;  he  who  reproduces  them  in  the  same  way  and  in  the 
same  words  as  the  rightful  owner,  without  acknowledgment,  ex 
poses  himself  to  the  danger  of  being  suspected  of  dishonest  deal 
ings  in  all  his  subsequent  literary  labours ;  while  his  misdemeanors 
cast  a  stigma  on  the  professional  body  to  which  he  belongs,  reflect 
injuriously  on  the  scanty  literature  of  the  land,  and  may  naturally 


XVI  LETTER  TO   CHARLES   D.   MEIGS. 

cause  the  productions  of  other  and  more  honest  writers  to  be  re 
ceived  with  caution,  or  to  be  overlooked  entirely,  lest  they  also 
may  be  a  transcript  of  works  already  known. 

But  I  have  said  more  than  I  had  intended,  and,  soliciting  your 
indulgence  for  my  loquacity, 

I  remain,  rny  dear  Doctor, 

Very  affectionately  and  gratefully, 
Your  friend, 

R  LA  ROCHE. 

WASHINGTON  SQUARE  : 

January  12,  1854. 


CONTENTS. 


CHAPTER    I. 

PAGE 

BELIEF  IN  THE  CONNECTION  OF  PNEUMONIA  WITH  AUTUMNAL  FEVERS  LONG  ENTER 
TAINED.         .............       33 

Pneumonia  common  where  fevers  seldom  or  never  are  seen     ...       56 
Pneumonia  not  necessarily  prevalent  where  fevers  are  common        .         .       61 
The  two  diseases  prevail  in  different  seasons  ......       68 

They  appear  under  the  influence  of  opposite  winds          .         .         .         .73 

Pneumonia  is  of  yearly  occurrence — not  always  so  fevers       .         .         .77 
Their  altitudinal  range  is  not  the  same  .  80 


CHAPTER    II. 

EXISTENCE  AND  MORBID  AGENCY  OF  MALARIA 101 

The  agency  of  malaria  not  universally  admitted      .         .         .         .         .110 

Objections  made  to  the  agency  of  malaria,  various  .         .         .         .112 

The  appearance  of  fever  where  there  are  no  marshes  does  not  disprove 
the  agency  of  malaria         .         .         .         .         .         .         .         .         .113 

The  non-detection  of  malaria  in  the  atmosphere  no  proof  of  its  non- 
existence  and  agency  .         .         .         .         .         .         .         .         .116 

Fever  not  due  to  the  action  of  any  known  gases     .         .         .         .         .118 

Not  true  that  nothing  is  found  in  the  atmosphere  of  sickly  localities        .     120 
Chemists  not  more  successful  in  discovering  other  morbid  poisons  in  the 
atmosphere         ...........     124 

Nature  and  condition  of  fever  localities  lead  to  the  opinion  of  the  exist 
ence  of  malaria  ..........     128 

The  danger  of  an  attack  of  fever  increased  in  proportion  to  proximity  to 
such  localities     .         .         .         .         .         .         .         .         .         .         .130 

These  effects  are  not  due  to  heat  alone   .         .         .         .         .         .         .134 

Fevers  are  not  the  effects  of  humidity  alone  .         .         .         .         .         .139 

A  high  dew-point  not  sufficient  to  account  for  the  occurrence  of  fever     .     163 
Heat  and  humidity  combined  not  the  efficient  cause  of  fever  .         .         .168 
Vicissitudes   of   temperature   will   not   account   for   the    occurrence    of 
periodic  fever      .         .         .         .         .         .         .         .         .         .         .169 

The  attack  is  sometimes  too  sudden,  and  follows  on  too  transient  an  ex 
posure  to  infected  regions,  without  appreciable  atmospheric  vicissitudes, 
to  be  the  effect  of  these  or  any  other  kindred  cause     .         .         .         .173 

Fever  not  the  effect  of  a  particular  electrical  state  of  atmosphere  .         .     177 

2 


xviii  CONTENTS. 

PAGE 

The  preceding  facts  lead  to  the  belief  in  a  poisonous  agent  floating  in  the 

atmosphere         .         .         .         .         .         .         .         .         .  -      .         .  177 

The  innocuousness  of  some  marshes,  and  of  localities  similar  to  those  that 

are  sickly,  no  proof  of  the  non-existence  or  non-agency  of  malaria      .  178 

The  exemption  may  be  explained  in  various  ways  .....  184 

Elevation 187 

Degree  of  heat 191 

Sheltering  from  the  action  of  the  sun     .         .         .         .         .         .         .194 

Free  ventilation      ...........  194 

Humidity  of  the  soil       .                   198 

CHAPTER    III. 

EXISTENCE  AND  MORBID  AGENCY  OF  MALARIA,  CONTINUED   .....  201 

Occurrences  on  shipboard  prove  the  agency  of  malaria  ....  201 

The  cause  of  fever  wafted  by  winds  passing  over  sickly  localities    .         .  209 
The  effects  of  drying,  overflowing,  and  reclaiming  marshy  •ftnd  sickly 

localities,  and  vice  versa,  prove  the  existence  and  agency  of  malaria     .  220 

The  first  effects  of  clearing  land,  £c.  injurious        .         .         ...         .  221 

Partial  draining  injurious       .........  223 

Injurious  effects  of  the  overflow  of  land          ......  224 

Bad  effects  of  copious  rains  followed  by  great  and  desiccating  heat          .  234 

Injurious  effects  of  upturning  the  earth  in  hot  weather  ....  238 

Beneficial  effects  of  complete  drainage    .......  244 

As  cities  enlarge  and  improve,  malarial  fevers  decrease  in  them       .         .  254 
Beneficial  effects  obtained  from  the  draining  of  marshes  prove  the  exist 
ence  and  morbific  agency  of  malaria   .......  258 

The  effects  of  covering  sickly  places  with  water  lead  to  the  same  belief  .  260 


CHAPTER    IV. 

EXISTENCE  AND  MORBID  AGENCY  OF  MALARIA,  CONTINUED    .....  265 

The  effect  of  the  "  washing"  of  sickly  places  lead  to  the  same  belief       .  265 
Some  forms  of  malarial  fevers  resemble  diseases  produced  by  putrid  sub 
stances  introduced  into  the  circulation          .         .         .         .         .         .271 

The   geological  formation  of  sickly  localities,   and  the  plants  growing 

therein,  £c.,  lead  to  a  belief  in  the  malarial  doctrine  ....  273 

Cause  more  effective  near  the  surface  of  the  earth  than  at  a  distance       .  274 

Cause  of  fevers  destroyed  or  mitigated  by  sanative  measures           .         .  275 

Cause  arrested  by  trees,  £c.   .........  278 

Fever  arrested  by  removing  sources  of  infection      .....  283 

Fever  sometimes  connected  Avith  the  existence  of  certain  fogs  or  mists    .  284 

The  stagnant  water  of  marshes  injurious  to  health          ....  285 

A  paludal  atmosphere  enfeebles  health    .......  287 

Effect  of  a  paludal  atmosphere  on  the  duration  of  life     ....  291 

Cau.se  of  fever  produces  an  impress  of  greater  or  less  strength  on  all 

placed  under  its  influence    .........  293 


CONTENTS.  XIX 

PAGH 

The  cause  of  autumnal  fevers  produce  an  impress  on  the  lower  order  of 

animals  and  on  vegetables  .........  295 

The  great  diffusion  and  mortality  of  autumnal  fevers  is  explained  only  on 

the  supposition  of  the  cause  being  a  gaseous  poison  ....  298 

Autumnal  fevers  under  the  influence  of  various  exciting  causes  .  .  304 
The  malarial  origin  of  such  fevers  confirmed  by  the  violent  manner  the 

cause  often  acts          ..........  305 

The  cause  of  fever  extends  its  action  to  the  ibetus  in  utero  .  .  .  305 
The  cause  of  autumnal  fever  appears  to  be  neutralized  by  the  poison  of 

some  zymotic  diseases  which  have  no  effect  on  common  complaints  .  308 

Cause  of  autumnal  fever  antagonistic  to  that  of  some  other  diseases  .  310 
Other  objections  urged  against  the  malarial  origin  of  periodic  or  autumnal 

fevers                                                                                                             ,  320 


CHAPTER    V . 

PNEUMONIA  AND  AUTUMNAL  FEVER  COMPARED  IN  REFERENCE  TO  THEIR  CAUSES, 
MODE  OF  PROGRESSION,  SYMPTOMS,  ANATOMICAL  CHARACTERS,  AND   THE  CIR 
CUMSTANCES  BY  WHICH  THEY  ARE  INFLUENCED         ......     335 

The  causes  of  autumnal  fevers  and  pneumonia  are  different    .         .         .     335 
Causes  of  pneumonia      ..........     347 

Autumnal  fevers,  if  not  produced  like  other  zymotic  diseases,  are  localized 
in  certain  places ;  not  so  pneumonia  .......     354. 

The  opinion  is  incorrect,  for  it  leads  to  the  inference  that  the  same  cause 
produces  diseases  differing  widely  in  symptoms  and  anatomical  cha 
racters  358 

Affinity  of  morbific  and  therapeutic  agents  for  special  organs  not  to  be 
denied         ............     359 

Distinctive  symptoms  and  pathological  conditions  different  in  pneumonia 
and  malarial  fevers     ..........     361 

Odour  of  the  surface  peculiar  in  some  malarial  diseases ;  not  so  in  pneu 
monia         ............     370 

The  condition  of  the  urine  different  in  the  two  diseases  .         .         .     374 

Anatomical  characters  different  in  the  two  diseases         ....     377 

The  t\vo  diseases  differ  widely  as  regards  the  duration  of  the  process  of 
incubation  ...........     380 

Process  of  latency  governed  by  definite  laws  ......     387 

In  some  forms  of  autumnal  fever  the  susceptibility  of  the  system  exhausted 
by  one  attack — not  so  in  pneumonia  .......  395 


CHAPTER    VI. 

PNEUMONIA  AND  AUTUMNAL  FEVERS  COMPARED  IN  REFERENCE  TO  THE  POWERS  OF 
ACCLIMATIZATION — AGES,  SEXES,  AND  RACES  OF  THOSE  AFFECTED:  PREVALENCE 
OF  THE  TWO  DISEASES  AT  THE  SAME  TIME,  AND  IN  RAPID  SUCCESSION,  NO  PROOF 
OF  IDENTITY  .............     403 

The  power  of  acclimatization  does  not  extend  to  pneumonia    .         .         .     403 


XX  CONTENTS. 

PAGE 

Pneumonia  and  autumnal  fevers  affect  different  races      .         .         .         .411 

Difference  of  susceptibility  of  the  two  sexes  .         .         .         .         .         .418 

Difference  of  susceptibility  of  the  two  diseases  at  different  periods  of  life     421 
Effects  of  the  passions  and  emotions  in  the  two  diseases          .         .         .     425 
The  prevalence  of  the  two  diseases  at  the  same  time  and  in  rapid  succes 
sion  no  proof  of  identity     .........     428 

Pneumonia  and  autumnal  fevers  are  not  convertible  diseases  .  ,     438 


CHAPTER    VII. 

PNEUMONIA  AND  AUTUMNAL  FEVERS,  ALTHOUGH  INDEPENDENT  OF  EACH  OTHER,  AS 
REGARDS  NATURE  AND  CAUSE,  COMBINE  TOGETHER,  AND  FORM,  LIKE  OTHER  COM 
PLAINTS,  HYBRID  DISEASES,  WHICH  MUST  NOT  BE  CONSIDERED  AS  PECULIAR 
FORMS  OF  EITHER  ............  437 

Cases  of  pneumonia  marked  by  symptoms  appertaining  to  autumnal 
fever,  are  the  results  of  complications  ......  437 

The  complication  of  diseases  more  or  less  distinct  in  their  nature,  and  the 
modifying  influence  of  epidemic  over  other  complaints,  are  well  known 
to  etiologists  and  pathologists  ........  452 

Diseases  arising  from  various  species  of  malaria  mix  together  and  form 
compounds  ...........  461 

Diseases  due  to  specific  contagious  poisons  amalgamate  together,  or  with 
other  complaints,  and  form  hybrid  complaints,  or  exist  together  in  the 
same  subject  ...........  465 

Pneumonia,  like  other  inflammations,  sometimes  assume  a  periodic  type, 
independently  of  a  malarial  influence  ......  468 

The  success  of  the  anti-periodic  treatment  in  pneumonia — supposing  it 
true — no  proof  of  the  identity  in  question  ...  .  471 

The  hypothesis  of  the  identity  of  pneumonia  with  autumnal  fever  not 
supported  by  facts  and  solid  arguments 480 


PNEUMONIA 


AND 


AUTUMNAL    FEVERS. 


CHAPTER    I. 

BELIEF  IN  THE  CONNECTION  OF  PNEUMONIA  WITH 
AUTUMNAL  FEVERS  LONG  ENTERTAINED. 

THE  idea  of  a  close  connection,  as  regards  both  causation  and 
nature,  between  thoracic  inflammations  and  malarial  fevers  of  vari 
ous  grades  and  types,  has  long  been  entertained,  and  continues 
evren  now  to  be  advocated  by  writers  of  respectable  standing. 
Casually  suggested,  or  openly  avowed  and  sustained  at  various  pe 
riods  by  professional  authorities  on  the  other  side  of  the  Atlantic, 
it  has  met  with  special  favour  in  this  country,  particularly  in  our 
Southern  and  Southwestern  States,  where  it  now  enlists  many 
warm  and  uncompromising  defenders.  Singular  as  it  may  appear 
to  modern  etiologists  and  pathologists,  that  a  connection  of  the 
kind  should  have  been  made  the  subject  of  serious  consideration 
by  our  forefathers,  and  still  more,  that  it  should  receive  the  sanction 
of  physicians  of  the  present  age,  it  requires  but  a  slight  acquaint 
ance  with  the  medical  literature  of  past  and  present  times,  to  be 
aware  of  the  reality  of  the  fact.  To  those  who  have  not  directed 
their  attention  to  the  subject,  a  few  references  to  the  writings  of 
preceding  and  contemporary  authors  may  not  be  unacceptable. 

The  retrospect,  if  not  otherwise  serviceable,  may  do  some  good 
by  contributing  to  open  the  eyes  of  the  modern  advocates  of  this 
belief,  to  the  fact  that  they  are  treading  on  ground  already  and 
frequently  travelled 'over  and  as  frequently  abandoned ;  and  that, 
consequently,  whatever  credit  they  may  expect  for  the  ingenuity 
displayed  in  its  support,  they  must  sedulously  avoid  laying  claims 
3 


34  PNEUMONIA    AND 

to  originality ;  while  in  the  progress  of  our  inquiries,  enough,  it  is 
hoped,  will  be  said  to  shake  their  belief  in  the  infallibility  of  their 
views,  and  to  lead  them  to  turn  their  attention  to  objects  more 
worthy  of  serious  investigation.  I  would  hope,  at  the  same  time, 
to  guard  unprejudiced  readers  against  adopting  without  mature 
examination,  all  that  has  been  or  may  be  said  in  opposition  to  the 
independent  existence  of  the  aforesaid  diseases. 

If  we  open  the  records  of  medicine,  and  inquire  into  the  views 
entertained  at  various  times  respecting  the  sources  of  febrile  com 
plaints,  more  particularly  of  that  variety  now  classed  under  the 
denomination  of  periodic  or  autumnal,  we  shall  find,  that  the  sup 
position  of  their  being  produced  by  morbid  agencies  of  a  general 
character,  but  differing  materially  from  the  mere  changes  in  the 
ordinary  and  sensible  qualities  of  the  atmosphere  to  which  inflam 
matory  diseases  of  membranous  and  parenchymatous  parts  are 
usually  due,  may  be  traced  to  a  very  early  period,  and  that,  passing 
through  successive  ages  to  the  present  time,  it  has  finally  assumed 
the  shape  of  a  distinct  theory.  By  some  writers  they  are  attributed  to 
various  mysterious  constitutions  of  atmosphere.  Others  see  in  them 
the  effects  of  peculiar  conditions  of  the  surrounding  medium — certain 
secret  influences  appertaining  in  a  special  manner  to  each  separate 
season.  Others,  again,  speak  of  exhalations  issuing  from  the  bowels 
of  the  earth ;  while  another,  and  more  numerous  set,  refer  them  to 
miasmata  exhaled  from  organic  matter — animal  or  vegetable,  or 
both — in  a  state  of  decomposition.  But  although  autumnal  fevers 
— remittent  and  intermittent — were  at  a  remote  period,  and  to  this 
day  continue  to  be,  considered  as  the  offspring  of  a  distinct  or  spe 
cific  cause,  or  of  some  peculiar  modification  of  ordinary  morbific 
agencies,  the  theory  has  not  escaped  opposition.  So  far  from  this,  it 
is  not  uncommon  to  find  medical  writers  of  former  and  even  modern 
times,  upholding  the  opinion,  that  thoracic  and  other  phlegmasiae — 
some  forms  of  them,  at  least — arise  from  causes  identical  with,  or 
closely  allied  to  those  that  give  rise-  to  the  above-mentioned  variety 
of  idiopathic  fevers ;  or  rather  viewing  the  latter  as  often  produced  by 
causes  known  to  occasion  common  inflammation  and  vice  versa"  and 
as  a  natural  consequence  regarding  them  all  as  mere  modifications  of 
one  and  the  same  disease.  Now,  without  reverting  to  the  numerous 
illustrations  of  the  latter  opinion,  scattered  through  the  valuable  vo 
lumes  handed  down  to  us  by  the  physicians  of  Greece  and  Kome,  but 
coming  down  at  once  to  the  seventeenth  century,  we  find  that  Eamaz- 


AUTUMNAL    FEVEKS.  35 

zini  ascribes  the  apoplexies,  quinsies,  catarrhs,  pleurisies,  and  in 
flammations  of  the  lungs,  which  occurred  extensively  at  Modena 
in  1691,  to  the  same  unhealthy  state  of  the  air,  induced  by  the 
wet  condition  of  the  soil  and  subsequent  desiccating  action  of  the 
sun,  to  which  he  refers  the  intermitting  fevers  of  spring,  and  the 
double  tertians  and  semi-tertians  of  summer  and  autumn.  In  some 
of  the  epidemics  described  by  others — predecessors  and  contempo 
raries  of  Lancisi — febrific  exhalations  are  represented  as  giving 
rise  to  diseases  which  they  call  dysentery,  apoplexy,  rheumatism, 
and  peripneumonia.  Lancisi1  himself,  in  tracing  the  history  and 
progress  of  an  epidemic  of  rheumatism  which  prevailed  at  Kome 
in  the  year  1709,  ascribes  it  to  a  like  cause.  The  disease  spread 
extensively,  contemporaneously  with  the  usual  fevers  of  the  sea 
son.  Many  of  the  cases  were  characterized  by  inflammation  of 
the  throat,  of  the  windpipe,  the  pleura,  the  lungs,  &c.,  all -of  which 
are  referred  to  the  operation  of  the  same  cause  which  gave  rise 
to  the  fever.  The  same  Lancisi  admitted  that  fevers  occasionally 
arise  from  a  cause  distinct  from  miasmal  exhalation; — the  un genial 
north  winds,  and  the  intemperies  resulting  therefrom  ;  the  very 
morbid  influences  which  he  recognizes  as  productive  of  pneumonic, 
rheumatic,  and  other  inflammations. 

By  Sydenham,  similar  views,  respecting  the  pathological  and  eti- 
ological  identity  of  the  diseases  in  question,  were  evidently  enter 
tained.  To  this  eminent  physician  and  accurate  observer,  the  doc 
trine  of  the  malarial  origin  of  endemic  or  epidemic  fevers  does  not 
appear  to  have  been  known;  or  if  known,  to  have  proved  admissi 
ble.  Sydenham  speaks,  it  is  true,  of  exhalations  from  the  bowels 
of  the  earth,  as  the  productive  agent  of  epidemics ;  but,  far  from 
apportioning  them  to  the  production  of  autumnal  fevers  exclusively, 
and  attributing  other  diseases  to  different  morbific  influences,  he 
seems  to  view  them  simply  as  the  cause  of,  or  an  adjunct,  to  those 
general  modifications  of  the  atmosphere  which,  under  the  name  of 
medical  constitutions  and  latterly  of  meteorations,  have  been  the  sub 
ject  of  so  much  comment,  and  to  which  he  refers  all  epidemic  dis 
eases,  whether  of  a  strictly  febrile  character,  or  marked  by  thoracic 
inflammation.  He  nowhere  attributes  fevers  to  a  special  cause  ex 
haling  from  the  surface  of  the  earth  itself,  or  from  extraneous  sub 
stances  existing  thereon,  in  the  sense  referred  to  by  Lancisi  and 

1  De  Noxiis  Paludum  Effluviis,  Op.  ii.  103. 


36  PNEUMONIA    AND 

subsequent  writers.  His  readers  will  recollect  the  remarks  he 
makes  under  the  head  of  "  Epidemics."  There  are  different  con 
stitutions  in  different  years.  They  originate  neither  in  their  heat 
nor  their  cold,  their  wet  nor  their  drought ;  but  they  depend  upon 
certain  hidden  and  inexplicable  changes  within  the  bowels  of  the 
earth.  By  the  effluvia  from  these,  the  atmosphere  becomes  contami 
nate,  and  the  bodies  of  men  are  predisposed  and  determined,  as 
the  case  may  be,  to  this  or  that  complaint.  This  continues  during 
the  continuance  of  this  or  that  constitution,  which,  after  the  cycle 
of  a  few  years,  gives  ground  and  makes  way  for  another.1  But 
they  will  recollect  at  the  same  time,  that  the  remarks  of  the  En 
glish  Hippocrates  applied  to  epidemics  generally,  as  well  to  the 
epidemic  cough  of  1675,  with  pleurisy  and  peripneumony,  as  to 
the  continued  and  intermittent  fevers  of  other  years.  In  all,  the 
terrestrial  effluvia  was  supposed  to  predispose  the  system  to  a  par 
ticular  form  of  disease,  which  other  causes,  differing  but  little  from 
each  other,  whatever  the  characters  of  the  epidemic  might  be,  ex 
cited  into  action.  They  were  all,  therefore,  regarded  as  closely  allied 
to  each  other  with  reference  to  causation.  Indeed,  we  have  proof 
enough  in  the  accounts  Sydenham  gives  us  of  the  epidemic  consti 
tutions  of  various  seasons — of  1674-1675,  for  example — that  he  re 
garded  the  cases  of  pleurisy  and  pneumonia,  which  then  occurred,  as 
"really  and  substantially  nothing  more  than  peculiar  forms"  of  the 
reigning  fever.  "  Sometimes,"  he  remarks,  "  it  (the  fever)  attacked 
the  head,  sometimes  the  bowels.  It  everywhere  put  on  the  symp 
toms  of  the  particular  part  affected.  Such  was  the  case  till  the  end 
of  October.  At  that  time  the  weather,  which  had  been  as  warm 
and  as  mild  as  summer,  suddenly  changed  to  wet  and  cold.  This 
brought  on  coughs  and  catarrhs,  which  were  more  numerous  than 
I  remember  them  to  have  been.  What,  however,  is  of  more  im 
portance,  is  the  fact  that  upon  these  coughs  supervened  the  station 
ary  fever  of  the  year ;  and  this  having  once  taken  its  hold,  increased, 
and  varied  in  some  of  its  symptoms  from- the  fever  of  the  previous 
part  of  the  year.  The  attack  of  the  previous  fever  had  been  chiefly 
determined  towards  the  head  and  bowels.  That  of  the  present  was 
towards  the  lungs  and  pleura,  and  as  such  gave  rise  to  symptoms 
of  pneumonia  and  pleurisy."2  In  1675,  "the  coughs  paved  the  way 
to  fever,  and  passed  without  difficulty  into  it.  Meanwhile,  just  as 

1  Works,  i.  33-4 ;  Ed.  of  Sydenliam  Society.  2  Ibid.  205. 


AUTUMNAL    FEVERS.  37 

the  coughs  helped  the  constitution  in  producing  the  fever,  so  also 
was  the  fever  determined  by  the  coughs  to  the  lungs  and  pleura. 
These  it  attacked  just  as,  a  week  before,  it  had  attacked  the  head. 
This  sudden  change  inclined  the  unthinking  to  consider  the  fever 
as  an  essential  pleurisy,  or  an  essential  peripneumony.  Yet  it  was 
neither  more  nor  less  than  what  it  had  been  throughout."1 

Even  at  a  time  when,  with  the  progress  of  knowledge,  febrile 
complaints  began  to  be  more  definitely  traced  to  separate  and  spe 
cial  causes  distinct  from  those  occasioning  parenchymatous  and  mem 
branous  inflammations  of  the  lungs,  some  authors  of  repute,  from 
whom  better  things  might  have  been  expected,  continued  to  refer 
these — certain  forms  of  them  at  least — especially  when  they  spread 
extensively,  and  presented  unusual  phenomena  and  a  tendency  to 
assume  a  periodic  type,  to  the  same  agencies  as  usually  give  rise  to 
epidemic  and  endemic  fevers.  Of  this  we  have  an  example  in  no 
less  a  man  than  Cleghorn,  who,  in  his  account  of  the  bilious  pleu 
risy  which  spread  epidemically  in  Minorca  during  the  latter  part  of 
1745  and  beginning  of  1746,  and  forms  the  subject  of  one  of  the 
most  interesting  chapters  of  his  invaluable  work,  expresses  himself 
on  that  matter  in  terms  that  can  scarcely  be  misunderstood.2 

The  disease  commenced  like  an  ague  fit,  with  shivering  and 
shaking ;  flying  pains ;  bilious  vomiting  and  purging,  succeeded  by 
quick  breathing;  immoderate  thirst;  inward  heat;  headache,  and 
fever.  It  observed  a  remittent  type,  and  on  the  third  or  beginning 
of  the  fourth  day,  there  was  frequently  a  great  remission;  some 
times  a  total  cessation  of  every  violent  symptom. 

But,  on  the  fourth  or  fifth,  the  disease  was  aggravated,  and  the 
patient  expired  in  a  day  or  two,  either  suffocated  or  raving  mad. 
In  another  place,  this  distinguished  observer  remarks  that  "  the  anni 
versary  epidemical  fevers  in  Minorca  may  be  divided  into  two  classes 
— the  summer  and  winter  fevers.  The  former  break  out  in  June  and 
July,  and  cease  about  Januar}^  or  somewhat  sooner.  The  latter 
seldom  appear  before  November,  and  are  rarely  seen  after  the 
summer  solstice.  Both  these  classes  of  f.  vers,  and  indeed  almost  all 
others  which  happen  in  that  climate,  whether  primary  or  symp- 
tomatical  diseases,  may  be  termed  periodical,  having  remissions  at 
intervals  more  or  less  considerable.  But  those  of  the  summer  gene- 

1  Works,  i.  22G;  Ed.  of  Sydenham  Society. 

2  Observations  on  the  Epidemic  Diseases  in  Minorca,  257-261. 


38  PNEUMONIA    AND 

rally  assume  some  one  or  other  of  the  tertian  types,  being  worse  one 
day  and  better  the  next,  alternately ;  whereas,  the  winter  fevers, 
though  they  often  counterfeit  tertians,  especially  in  their  beginning, 
yet,  for  the  most  part,  have  exacerbations  equally  strong  every  day. 
It  may  likewise  be  remarked  that  as  the  summer  fevers  are  gene 
rally  complicated  with  fluxes  and  painful  obstructions  in  the  chylo- 
poietic  viscera,  so  are  those  of  the  winter  with  coughs,  catarrhs,  and 
topical  inflammations  of  the  vital  organs;  the  brain;  the  lungs ; 
the  heart  itself." 

Pleurisy,  therefore,  according  to  this  view  of  the  subject,  is 
nothing  more  nor  less  than  a  modification  of  marsh  or  periodic 
fever,  or  a  form  of  the  disease  of  which  common  periodic  fever  con 
stitutes  another  form ;  the  difference  between  them  depending  on 
difference  of  the  parts  pathologically  implicated,  and  this  in  its  turn 
being  due  to  the  difference  of  the  particular  atmospheric  influence 
giving  rise  to  the  disease; — the  cold  of  winter  being  the  exciting  cause 
of  the  one  form,  and  the  heat  of  summer  the  exciting  cause  of  the 
form  peculiar  to  that  season.  Indeed,  we  cannot  discover  that  Cleg- 
horn  anywhere  attributes  pulmonary  inflammations  and  fevers  to 
separate  and  specifically  different  causes,  or  alludes  to  anything  more 
than  atmospheric  influences,  and  that  he  regarded  those  diseases  as 
essentially  different  in  a  pathological  point  of  view.  As  the  one 
declines  the  other  appears.  The  former  is  the  chief  among  the 
vernal  epidemics,  as  the  other  is  constantly  foremost  among  the 
autumnal.  They  are,  to  all  intents  and  purpose?,  one  and  the  same 
disease ;  the  only  difference  being  in  the  local  affections  that  may 
supervene  during  their  course,  and  by  which  they  may  be  compli 
cated  ;  a  diversity  itself  due  to  peculiar  thermometric  changes. 

Long  after  Cleghorn,  Dr.  Wells  advocated  the  opinion  of  the 
existence  of  a  connection  between  malarial  fevers  and  inflamma 
tory  diseases  of  the  lungs.  Whether,  however,  this  connection  was 
thought  by  him  to  imply  the  existence  of  a  close  pathological  and 
etiological  alliance  or  identity,  is  a  question  I  have  not  been  able 
to  find  out.  It  was  founded  on  the  circumstance  that  the  two  dis 
eases  exist  at  the  same  time,  or  succeed  each  other ;  and  that  those 
who  have  the  one  disease  in  one  season,  are  liable  to  have  the  other 
in  the  next.  Thus,  Dr.  Wells  was  told  by  his  preceptor,  Dr.  Gar 
den,  who  had  practised  in  South  Carolina,  that  he  had  found  that 
those  who  suffered  severely  in  the  autumn  from  intermittents,  were 
the  most  liable  to  pleurisy  in  the  spring.  "Dr.  Chalmers,  another 


AUTUMNAL    FEVERS.  39 

physician  of  South  Carolina  (Essay  on  Fevers),  has  said  that  nothing 
more  frequently  happens  in  that  country  than  the  accession  of  an 
intermittent  a  day  or  two  after  the  removal  of  a  pleurisy.  In  the 
year  1777, 1  saw  the  remark  of  Dr.  Garden  confirmed  in  a  regiment 
of  soldiers,  stationed  in  Guelderland,  part  of  which  had  been  quar 
tered  the  preceding  autumn  in  Zealand.  In  a  report  made  by  Dr. 
Blane,  Dr.  Borland,  and  Dr.  Lempriere,  to  the  British  Government, 
in  October,  1809,  on  the  sickness  of  our  troops  in  Zealand,  it  is 
mentioned,  on  the  authority  of  the  inhabitants,  that  such  of  our 
soldiers  as  had  suffered  from  intermittents  in  the  autumn  would 
run  the  risk  of  being  cut  off  by  inflammatory  diseases  in  the  winter 
and  spring.  No  mention,  indeed,  is  made  of  the  particular  kinds 
which  would  then  prevail ;  but  what  is  said  of  their  fatality,  seems 
to  show  that  inflammations  of  the  chest  were  chiefly  referred  to ; 
and,  at  an/^ate,  it  is  certain  that  these  diseases  must  have  been 
included  under  the  general  term  inflammatory."  Dr.  Wells  farther 
appeals  to  Huxham  (20),  to  show  that  fevers  sometimes  are  rife  and 
contemporary  w,ith  epidemic  pleurisies  and  peripneumonies ;  also 
to  Cleghorn,  for  the  fact  that,  at  Minorca,  pleurisies  are  generally 
the  chief  among  the  vernal  epidemics,  as  tertian  intermittents  are 
constantly  among  the  autumnal ;  and,  in  addition,  states,  on  the 
authority  of  Drs.  Weeks,  of  Sussex,  and  Harrison,  of  Horncastle,  as 
well  as  his  own,  that,  with  the  decrease  of  intermittents  in  some 
parts  of  England  and  London,  there  has  been  a  like  decrease  of 
pleurisies.1 

Those  who  in  Italy,  England,  France,  and  this  country,  deny  or 
doubt  the  agency  of  malaria  in  the  production  of  periodic  fever, 
though  not  all,  so  far  as  I  know,  going  the  length  of  regarding 
pneumonia  and  other  thoracic  diseases  as  nothing  more  than  pecu 
liar  forms  of  such  fevers,  cannot  but  believe  in  their  close  alliance 
with  these,  viewing,  as  they  do,  the  latter  as  proceeding  from  the 
agency  of  much  the  same  causes  as  occasion  the  former.  "  That  a 
residence  in  marshy  countries,  says  one  of  these  writers,  subjects  to 
intermittent  fevers,  is  an  undeniable  fact ;  and  that  they  who  live 
on  broken,  hilly  districts,  are  liable  to  pulmonary  diseases  is  also 
unquestionable.  If  locality  explain  the  latter,  it  may  equally  ex 
plain  the  former,  without  recurrence  to  imaginary  agencies.  In  the 
same  county  of  Lincoln,  in  England,  the  inhabitants  of  the  fens  are 


1  Trans,  of  a  Soc.  for  the  Improvement  of  Med.-Chir.  Knowledge,  iii.  5 


37-0 


40  PNEUMOXIA    AND 

sufferers  from  intermittent  fevers ;  those  of  the  wolds  or  hills,  are 
obnoxious  to  catarrh,  pleurisies,  and  phthisis.  If  an  exchange  be 
made  of  habitation  in  those  two  cases,  there  will  be  exchange  of 
diseases.  Why  then  demand  miasm  as  a  cause  of  fever,  and  refuse 
it  as  a  cause  of  pulmonary  disorders  ?"1  As  the  writer  regards  au 
tumnal  fevers,  from  the  simple  intermittent  to  the  malignant  yellow 
as  produced  by  heat,  cold,  humidity,  atmospheric  vicissitudes,  and 
the  like,  and  as  he  cannot  attribute  pulmonary  inflammation  to  other 
agencies,  it  follows  that,  according  to  him,  the  same  causes  may  give 
rise  to  both  sets  of  diseases,  which  hence,  cannot  differ  essentially  in 
a  pathological  point  of  view. 

Dr.  Kush  and  his  disciples  may  not  always  have  said,  in  positive 
terms,  that  pneumonia,  pleurisy,  and  other  kindred  affections,  are 
really  and  substantially  peculiar  forms  of  periodic  fever,  and  no 
thing  more ; — they  may  not  have  attributed  them  all  to  the  same 
morbid  agencies ;  but  in  upholding  the  doctrine  of  the  unity  of 
disease,  and  the  applicableness  of  the  same  treatment — modified 
only  in  point  of  energy,  and  as  regards  the  use  of  particular  means, 
by  the  condition  of  the  system  at  large,  and  the  nature  of  the 
parts  affected — they  admitted  the  pathological  identity  of  pneumonia 
with  periodic  fevers,  considering  them  both  as  constitutional  dis 
eases,  which  assume  different  forms  according  to  the  nature  of  the 
local  derangements  by  which  they  may  be  accompanied,  but  remain 
always  fundamentally  the  same.  Hence  we  find  that  eminent  phy 
sician  remarking:  "There  is  but  one  exciting  cause  of  fever,  and 
that  is  stimulus.  Heat,  alternating  with  cold,  marsh  and  human 
miasmata,  contagion  and  poisons  of  all  kinds,  intemperance,  pas 
sions  of  the  mind,  bruises,  burns,  and  the  like,  all  act  by  a  stimulating 
power  only,  in  producing  fever.  This  proposition  is  of  great  appli 
cation,  inasmuch  as  it  cuts  the  sinews  of  the  division  of  diseases 
from  their  remote  causes.  Thus  it  establishes  the  sameness  of  a 
pleurisy,  whether  it  be  excited  by  heat  succeeding  cold,  or  by  the 
contagion  of  the  smallpox  and  measles,  or  by  the  miasmata  of  the 
yellow  fever."  "There  is  but  one  fever.  However  different  the  pre 
disposing,  remote,  or  exciting  causes  of  fever  may  be,  whether  de 
bility  from  obstruction  or  action,  whether  heat  or  cold,  succeeding 
to  each  other,  whether  marsh  or  human  miasmata,  whether  intem 
perance,  a  fright,  or  a  fall,  still,  I  repeat,  there  can  be  but  one 

1  Bell  on  Miasm.     Philadelphia  Mod.  and  Phys.  Journ.  ii.  3 1C,  N.  S. 


AUTUMNAL    FEVERS.  41 

fever."1  A  little  farther  on,  lie  makes  several  forms  or  states  of 
fevers.  Of  these,  the  eighteenth  is  the  pulmonary,  which  includes 
true  and  bastard  pneumony,  acute  and  chronic  catarrh,  etc. 

Morton,  Lauder,  Sauvages,  Alibert,  Mongellaz,  Chauffard,  Com- 
paretti,  Gouzee,  Daniell,  Evans,  Abloing,  Brera,  Matthei,  Bailly,  and 
others,  to  whom  I  shall  again  have  occasion  to  refer,  describe  a 
pneumonic  form  of  intermittent  fever,  or  periodic  form  of  pulmonary 
inflammation,  produced  by  the  same  cause  as  ordinary  intermittents, 
and  thereby,  like  the  preceding  writers,  acknowledge  the  identity 
of  both  sets  of  phenomena  represented  in  the  compound. 

Not  very  different  were  the  views  of  the  late  Dr.  Robert  Jackson, 
of  the  English  Army,  whose  writings  on  the  yelloAV  fever  of  the 
West  Indies,  and  South  Coast  of  Spain,  as  also  his  volumes  on  the 
remedial  effects  of  cold  affusion  in  febrile  diseases  and  on  contagious 
fevers  have  enjoyed,  and  continue  to  enjoy,  a  merited  reputation. 
Fever,  according  to  this  distinguished  author,  is  a  form  of  changed 
or  perverted  organic  action,  "that  is,  a  new  form  of  life  impressed 
on  the  minuter  series  of  organic  capillaries,  varied  in  expression 
according  to  the-,  varied  structure  of  the  series  upon  which  the  act 
is  principally  manifested."  "The  diseased  act  is  liable  to  change, 
or  to  suffer  transfer  from  one  series  to  another,  in  various  ways 
and  manners,  and  at  various  points  of  time ;  and  thus  to  exhibit 
within  the  limit  of  the  total  duration,  a  scene  of  fluctuation  and 
uncertainty  which  is  more  or  less  embarrassing  to  the  observer."2 
After  stating  that  he  considers  endemic  fever,  whether  it  appears 
in  the  torrid  or  temperate  zones  of  the  earth,  to  be  radically  one 
disease,  he  remarks :  "  As  the  act,  whether  progressive  or  re 
gressive,  varies  under  contingencies,  so  it  changes  mode,  or 
suffers  transfer  from  one  series  to  another  at  certain  periods  of  its 
course,  to  such  an  extent  and  in  such  manner  as  to  appear  totally 
unlike  itself.  The  modes  of  febrile  action  are,  as  now  observed, 
numerous,  and,  as  superficially  varied,  totally  unlike  one  another. 
The  author  considers  them  as  resting  on  a  common  base,  conse 
quently  as  one  disease."  So  much  for  endemic  fevers — the  cause  has 
the  same  base  in  all  parts  of  the  earth,  modified  by  circumstances 
of  locality  in  different  districts  of  similar  latitudes,  so  as  to  present 
considerable  diversity  of  appearance  in  its  visible  operation.  It  is 

1  Outlines  of  the  Phenomena  of  Fever,  Works,  iii.  9,  10. 

2  A  Sketch  of  the  History  and  Cure  of  Febrile  Diseases,  i.  10,  11,  15.    Lond.  1820. 


42  PNEUMONIA    AND 

also  modified  by  elevation,  exposure,  and  the  revolution  of  seasons, 
circumstances  of  subjects,  &c.  Farther  on,  Dr.  Jackson  says:  "The 
outline  of  the  history  and  cure  of  fever,  which  is  given  in  the  pre 
ceding  pages,  applies  to  fever  as  a  disease  of  the  organic  system 
acting  on  a  general  base.  Fevers,  I  am  aware,  rarely  occur  at  any 
time,  where  some  one  part  does  not  suffer  more  prominently  than 
others  in  all  stages  of  the  course ;  but  the  term  general  is  here  affixed 
to  that  form  of  the  disease  where  the  predominance  is  fluctuating 
and  contingent;  /oca/,  where  it  is  prominent  at  the  commencement, 
and  where  it  continues  uniformly  prominent  throughout.  The 
cause  which  produces  inequality  in  the  force  and  mode  of  the  per 
verted  movements,  which  are  excited  by  the  action  of  the  cause  of 
fever  in  the  different  organs  of  the  system,  is  necessarily  obscure. 
I  do  not  pretend  to  explain  it,  and  I  only  take  leave  to  suggest,  that 
it  is  apparently  connected  with  the  unequal  conditicfll  of  organic 
sensibility  existing  at  the  time  the  morbid  cause  is  applied,  or  that 
it  explodes  into  action ;  a  condition  constitutional  or  contingent,  as 
depending  upon  the  operation  of  general  or  contingent  causes  to 
which  the  movements  of  animal  life  are  exposed."1 

We  have,  then,  according  to  this  view,  fevers,  which  are  diseases 
of  the  whole  system,  without  determinate  and  permanent  local  de 
terminations  ;  and  fevers  also  of  the  whole  system,  but  which,  un 
like  the  former,  manifest  their  action  more  permanently  in  particular 
organs :  among  the  latter,  we  have  the  forms  of  fever  located  in  the 
inferior  or  abdominal  cavity ;  the  gastric,  choleric,  dysenteric.  The 
forms  of  fever  with  local  action  in  the  superior  or  cranial  cavity ; 
the  forms  of  fever  with  local  disease  in  the  organs  of  the  thoracic 
cavity — the  pneumonic,  the  cardiac,  and  catarrhal ;  and  the  forms 
of  fever  with  external  local  action — the  ophthalmic  and  ulcerative. 
All  these  forms  are  produced  by  the  same  causes,  though  some  are 
more  particularly  noted  to  owe  their  origin  to  exhalations  from  the 
soil,  more  generally  or  more  partially  diffused ;  all  are  mere  modi 
fications  of  one  and  the  same  disease. 

"  The  pneumonic,"  adds  Dr.  Jackson,  "  is  an  important,  and,  in 
some  countries,  a  frequent  form  of  the  action  of  a  febrile  cause.  It 
is  more  common,  according  to  the  laws  of  the  annual  revolution,  in 
some  seasons  of  the  year  than  in  others ;  and  it  is  sometimes  epi 
demic  in  seasons  and  places  to  which  it  does  not  seem  to  belong."2 

1  Op.  cit.  ii.  1,  2,  &c.  2  Ibid.  p.  83. 


AUTUMNAL    FEVERS.  43 

If  anything  were  required  to  show  that  all  those  febrile  diseases 
with  local  determinations  were  placed  by  Dr.  Jackson  on  the  same 
footing,  pathologically  and  etiologically,  with  the  non-local  forms, 
it  might  be  derived  from  the  fact  that,  while  including,  as  we  have 
seen,  dysentery  and  some  other  complaints  among  the  former,  he 
remarks,  after  stating  that  on  plains  near  the  sea-coast,  muddy  rivers, 
bayous,  and  other  foul  grounds,  the  product  of  the  cause  is  usually 
remittent,  sometimes  intermittent:  "  The  action  of  the  morbid  cause, 
instead  of  being  what  is  commonly  called  febrile,  is  not  unfre- 
quently  dysenteric ;  sometimes  eruptive  and  ulcerative  on  dry, 
bare,  rocky,  and  hilly  positions  near  the  sea-coast,  or  in  positions 
where  water  flows  with  a  rapid  course." 

Dr.  Macculloch,1  though  furnishing  no  proof  of  the  correctness 
of  his  opinion,  and  admitting  that,  of  very  much  of  what  he  states  he 
has  no  personal  knowledge,  includes  among  the  diseases  produced  by 
malaria,  and  which  consequently  he  considers  as  mere  modifications 
of  the  legitimate  products  of  that  cause,  angina,  asthma,  oedema  of 
the  lungs,  and  catarrh  reaching  to  peripneumony.  Copland,  in  his 
article  catarrh,2  echoes  Macculloch,  so  far,  at  least,  as  the  latter 
disease  is  concerned,  and,  under  another  head,  refers  catarrhal  fever 
to  the  same  cause  as  intermittents,  enlarged  spleen,  torpid  states  of 
the  liver,  and  rheumatic  attacks,  i.  e.  to  "  miasms  from  decayed 
vegetable  matter,  aided  by  moisture,  in  temperate  ranges  of  atmo 
spheric  heat." 

An  intelligent  writer  of  our  own  country,  the  late  Dr.  Yaughan, 
of  Wilmington  (Delaware),  in  an  Essay  on  the  diseases  of  that 
State,  alluding  to  those  of  winter  and  spring,  remarks  that  a  respite 
is  then  obtained  from  the  attacks  of  ague,  and  a  new  order  of  dis 
eases  arises  from  sudden  transitions  of  temperature.  The  general 
character  of  the  prevailing  complaint  is  peripneumonia  notha,  in  the 
majority  of  cases ;  but  too  much  stress,  he  thinks,  is  laid  on  the 
local  affection,  and  too  little  on  the  general  state  of  the  system ;  and 
he  farther  maintains  that,  from  the  state  of  the  pulse,  the  frequent 
sighing  in  respiration,  the  tendency  of  the  fever  to  assume  a  tertian 
type,  the  early  appearance  of  the  hippocratic  countenance,  "  it  be 
longed  to  the  genus  of  autumnal  fevers,  varied  by  the  casualties  of 
the  atmosphere."  "  It  may  be  said  that  this  is  too  far  strained,  and 
that  frost  destroys  marsh  miasmata  as  a  tropical  plant.  Granted  : 

1  On  Malaria,  442.  2  Vol.  i.  272. 


44  PNEUMONIA    AND 

when  the  ponds  are  covered  with  ice,  exhalation  is  overpowered ; 
but  if  these  fevers  suffer  a  common  fate  with  their  causes,  why  do 
intermittents  exist  or  occur  in  winter,  and  winter  quartans,  the  most 
obstinate  of  the  whole  tribe?  Why  do  valetudinarians  suffer  re 
lapses  in  the  frosts  of  January  and  February  ?  And  why  are  per- 
sons  on  a  removal  from  a  marshy  to  a  high  country  attacked  with 
the  endemial  fevers  of  the  fens,  if  the  remote  cause  be  not  dormant 
in  the  system,  and  excited  into  action  by  a  concurrence  of  predispos 
ing  causes?  These  facts,  I  presume,  substantiate  the  position  that 
our  winter  diseases  are  but  varied  forms  of  the  autumnal  fever."1 

In  an  account  of  the  diseases  which  occurred  at  Fort  Gibson  (Ar 
kansas),  during  the  last  quarter  of  1833,  Dr.  Forry  states,  on  the 
authority  of  Dr.  Pitcher,  and  Dr.  Wharton,  of  the  army,  that  most 
of  the  cases — pleurisies,  cholera,  rheumatism — partook  of  the  inter 
mittent  character,  and  adds :  "  The  strict  periodicity  of  these  affec 
tions,  and  their  subjection  to  the  same  remedies  which  are  found  to 
arrest  the  course  of  intermittent  fever,  implf  a  close  alliance,  if  not 
a  common  origin."2 

We  might  embrace,  in  this  category,  no  less  an  authority  than 
Broussais,  and  even  the  greater  number  of  his  more  enthusiastic 
disciples ;  for,  with  them,  all  fevers,  whether  of  a  continued,  remit 
tent,  or  intermittent  type,  are  nothing  more  than  so  many  varieties 
of  one  and  the  same  pathological  condition ;  inflammatory  irritation 
having  its  seat  in  one  and  the  same  tissue — the  gastro-enteritic  mucous 
membrane.  This  gastro-enteritis,  with  the  various  complications 
that  may  supervene,  are,  they  say,  produced  by  the  action  of  cold 
alone,  or,  as  is  more  frequently  the  case,  combined  with  humidity, 
or  through  the  agency  of  atmospheric  vicissitudes ;  or,  as  regards 
some  forms  of  the  disease,  of  malarial  exhalations.  But,  whichever 
.of  these  may  be  the  efficient  agent — heat,  cold,  humidity,  vicissitudes, 
or  malaria — the  effect  is  the  same.  It  is  always  gastro-enteritis, 
whether  with  or  without  the  addition  of  inflammatory  irritation  in 
other  organs  or  tissues.  There  is  nothing  specific  in  the  cause, 
and,  as  a  natural  consequence,  nothing  specific  in  the  effect  which 
that  cause  produces.  Heat,  cold,  malaria,  may  go  a  different  way 
about  it,  but  the  change  they  induce  in  the  system  is  similar,  and 
that  change  is  effected  in  the  gastro-enteritic  mucous  membrane. 
One  or  other  of  the  pyrexia3  is  the  consequence ;  the  difference  be- 

1  New  York  Med.  ilcpos.  iv.  130.  2  Climate  of  the  U.  S.  18G. 


AUTUMNAL   FEVERS.  45 

tween  them  being  due  to  a  variety  of  concomitant  circumstances, 
connected  with  external  influences  or  personal  peculiarities.  Pneu 
monia,  and  other  inflammations,  parenchymatous,  serous  or  mucous, 
differ  in  nothing  from  the  other  form  of  disease ;  they  are,  it  is  true, 
more  frequently  produced  by  cold  and  atmospheric  vicissitudes  than 
by  malaria.  But  the  effect,  after  all,  is  only  inflammation;  and,  as 
the  latter  presents  nothing  specific  in  its  character,  whatever  be 
the  part  it  may  show  itself  in,  it  follows  that  these  diseases  differ  in 
nothing  from  the  former  mentioned,  except  as  regards  the  parts 
inflamed ;  the  difference  being  due  to  the  mere  circumstance  that, 
at  the  approach  of  winter,  or  during  the  prevalence  of  atmospheric 
vicissitudes,  the  thoracic  organs  take  on  more  readily  the  inflam 
matory  action,  while  at  other  periods  the  gastro-enteritic  apparatus 
is  more  frequently  affected. 

More  recently,  Dr.  H.  A.  Kamsey,  of  Kaysville,  Geo.,  in  an  Essay 
on  Pneumonia,  published  in  the  early  part  of  1851,  has  advanced 
much  the  same  views,  Regarding  the  disease  as  the  product  of  the 
same  causes  as  occasion  intermittents,  and  hence,  as  identical 
with  these.1  And  at  a  still  later  period,  Dr.  A.  P.  Merrill,  Pro 
fessor  of  Materia  Medica  and  Therapeutics,  in  the  Medical  School 
of  Memphis,  Tenn.,  in  an  Essay  on  Pneumonia,  originally  inserted 
in  the  number  for  July,  1851,  of  the  New  Orleans  Med.  and  Surg. 
Journ.,  but  more  recently  issued  in  pamphlet  form,  conjointly 
with  two  other  essays,  has  adopted  a  similar  theory,  relative  to 
the  connection  in  question.  Asserting  it  more  positively,  and  with 
much  greater  distinctness  than  has  been  done  by  the  generality  of 
modern  writers,  and  regarding  it  as  fully  sanctioned  by  the  results 
of  a  long  experience,  acquired  in  the  South,  he  lays  down  as  an 
indisputable  fact,  that  pneumonia,  though  sometimes  appearing  as 
an  idiopathic  affection,  is  most  generally — whether  it  prevail  spora 
dically  or  as  an  epidemic — really  and  substantially  nothing  more 
than  a  peculiar  form  of  remittent  and  intermittent  fever,  in  which 
the  lungs,  from  sudden  transitions  of  temperature,  are  made  to  bear 
the  burden  of  local  disease. 

Other  authorities,  equally  respectable,  both  at  home  and  abroad,2 

1  A   Practical   Essay  upon   the   Symptomatology,   Etiology,  Vital   Statistics,  and 
Treatment  of  Pneumonia.  —  Charleston  Medical  Journal  and  Review,  vi.  1,  etc. 

2  Baronius,  Pleuro-pneumonia,  Ann.  1633.     Bovillat,  Mem.  sur  les  pleuro-pneu- 
monies  epidemiques,  556.     Good,  Study  of  Med.  ii.  424.     Hugh  Williamson,  Med. 
Register,  iii.  453.     Boott,  Life  of  Armstrong,  ii.  41,  290-1,  416.     Yates,  an  Essay  on 


46  PNEUMONIA    AND 

might  easily  be  found,  to  swell  the  list  of  the  advocates  of  the  views 
in  question  ;  but  the  preceding  will  amply  suffice  to  show  that  these, 
whether  having  reference  to  a  few  exceptional  cases  of  pneumonic 
inflammation,  or  to  the  disease  as  it  appears  always  and  every 
where,  and  as  it  presents  its  legitimate  characters,  have  long  enlisted 
the  attention  of  medical  inquirers,  and  continue  to  enumerate  warm 
supporters.1 

When  we  come  to  inquire  into  the  grounds  upon  which  the 
opinion  of  this  close  alliance  or  identity,  both  as  regards  the  patho 
logy  or  etiology  of  those  two  classes  of  diseases  is  predicated,  we  find 
that,  with  the  exception  of  Sydenham,  according  to  whom  the  differ 
ence  of  one  epidemic  disease  from  another  depended  on  a  variety  of 
atmospheric  constitutions,  and  who  contented  himself  with  describing 
the  symptoms,  progression,  &c.  of  the  complaints  he  observed  and 

the  Bilious  Fever  prevailing  in  the  State  of  New  York.  Albany,  1813,sp.  27.  Med. 
and  Phil.  Register,  iii.  488.  Sarcone,  Histoire  Raisonnee  des  Maladies  Observers 
a  Naples  pendant  le  cours  entier  de  1'Annee  1764,  i.  124-202. 

1  A  writer  in  one  of  the  Western  Medical  Journals  (Ohio  Medical  and  Surgical 
Journal,  i.  508)  remarks,  that  Malaria,  besides  giving  rise  to  all  varieties  and  species 
of  acute  febrile  disorders — from  the  highest  sthenic  to  the  lowest  asthenic  grade, 
induces  many  obscure  and  anomalous  forms  of  disease,  and  frequently  imparts 
new  features  and  tendencies  to  every  disorder  that  may  come  within  the  sphere 
of  its  influence.  That  it  makes  its  impressions  primarily  on  the  cerebra  spinal 
system,  can  hardly,  as  he  thinks,  admit  of  a  doubt.  The  morbid  impression  there 
made  may  be  transmitted  to  the  extremity  of  the  nerves  taking  their  origin  in  that 
system,  and  there  develop  its  evidences,  in  the  form  of  some1*  functional  or  organic 
derangement.  "The  viscera  of  the  chest,  abdomen,  and  pelvis,  and  the  fibrous 
cellular  tissues,  may  in  this  way  become  the  seat  of  disease,  from  reflected  malarious 
impressions.  Such  cases  are  common.  Many  affections  of  the  heart,  stomach,  intes 
tines,  and  liver,  and  in  females  uterine  disorders,  are  of  this  character.  They  have 
been  imperfectly  recognized  and  described  by  authors  as  "Irregular  and  masked  In 
termittent,"  "Complications,"  £c.  This  exciting  cause  may  restrict  its  action  solely 
to  the  nervous  system,  and  has  been  known  to  originate  or  complicate  with  every 
species  embraced  in  Cullen's  class  NEUROSES,  from  Apoplexy  down  to  Hysteria.  In 
other  instances,  it  may  take  a  wider  range,  and  show  its  effects  under  the  forms  of 
irritation,  inflammation,  and  I  might  properly  add,  every  disorder  to  which  the  human 
family  is  subject."  In  all  cases  of  malignant  erysipelas  that  have  come  within  the 
experience  of  this  writer,  "it  has  participated  largely,  either  as  an  exciting  or  modi 
fying  cause."  To  the  Western  physician,  it  is  added,  under  whose  observation  malaria 
is  daily  producing  such  effects,  their  diagnosis  is  often  a  source  of  perplexity ;  while 
to  the  members  of  the  medical  profession  in  the  Eastern  States,  "who  know  nothing 
of  such  diseases,  except  from  books  and  lectures,  it  is  a  perfect  stumbling-block." 

The  writer  of  these  remarks  is  Professor  of  Physical  Diagnosis  and  Theory  and 
Practice  of  Medicine  in  a  Western  medical  college. 


AUTUMNAL    FEVERS.  47 

troubled  himself  very  little  about  their  pathological  or  phenomenal 
relationship  ;  and  of  Dr.  Kush,  with  whom  the  idea  of  the  alliance 
in  question  was  the  natural  offspring  of  his  doctrine  of  the  unity  of 
diseases ;  most  of  the  writers  we  have  cited,  from  Cleghorn  down 
ward,  dwell  on  the  circumstance,  that  the  two  diseases — periodic 
fever  and  pneumonic  inflammation — are  found  to  prevail  simultane 
ously  in  the  same  localities,  or  to  succeed  to  each  other ;  that  while 
pulmonary  inflammation  often  occurs  in  summer  and  autumn,  when 
fevers  are  rife,  so  the  latter — even  intermittent^ — appear  also  in 
winter  and  spring,  when  the  former  usually  prevails  extensively. 

With  Dr.  Kamsey,  whose  observations  were  principally  made 
during  an  epidemic .  of  pneumonia  which  swept  over  Lincoln 
County,  Georgia,  in  1845,  the  proof  lies  principally  in  this:  that 
families  who  have  b'een  formerly  healthy  at  other  points,  become 
affected  by  intermittent,  febrile,  and  pneumonic  diseases,  by  moving 
to  a  malarious  location,  and  subsequently  healthy  by  removing  from 
it ;  that  on  that  remarkable  occasion,  when  out  of  a  population  of 
seven  thousand,  three  hundred  died  of  the  disease,  and  when  out  of 
one  hundred  and  seventy  cases  he  attended  it  was  his  good  fortune 
"not  to  have  sustained  the  loss  of  a  single  one,"  most  of  the  cases 
occurred  along  the  course  of  the  streams,  and  at  those  points  which 
rarely  escape  chill  and  fever ;  that  when  it  occurred  elsewhere  it 
could  be  accounted  for  by  the  fluctuations  of  the  seasons,  manure- 
piles,  swamps,  &C.;  which  then  and  now  exist  throughout  the  country 
to  a  greater  or  less  extent,  "  carrying  with  their  effluvia,  through 
the  medium  of  the  winds,  the  emanations  of  disease  (pneumonia  of 
course  among  these)  and  the  seeds  of  death,"  and  that,  in  ordinary 
times,  "those  who  make  most  manure,  and  have  their  lots  closest  to 
their  houses,  have  most  cases  of  pneumonia."  Pp.  12-16. 

Dr.  Merrill,  who  has  recently  taken  a  leading  part  in  the  defence 
of  the  opinion  in  question,  and  who,  on  more  accounts  than  one, 
deserves  to  be  listened  to  with  respect,  on  this  or  any  other  subject 
connected  with  the  diseases  of  our  Southern  States,  rather  boldly 
assumes  the  point,  than  attempts  to  prove  it,  and  remarks :  "  These 
fevers  occupy  the  attention  of  the  physician,  in  some  of  their  vari 
ous  shapes,  at  all  seasons  of  the  year,  both  in  town  and  country ; 
and  they  have  been  characterized,  at  various  times  and  in  various 
places,  by  a  great  multiplicity  of  names."  Again:  "This  protean 
character  of  our  fevers  arises  in  part  from  the  season  of  the  year, 
and  the  localities  in  which  they  occur ;  but  mainly  from  the  organs 


48  PNEUMONIA    AND 

of  the  body  which  become  involved  in  the  diseased  action,  the  pre 
dominance  of  inflammation  or  congestion,  and  the  character  of  their 
periodicity.  In  the  spring  we  are  apt  to  find  these  diseases  assuming 
names  which  have  reference  more  particularly  to  this  periodicity 
and  general  pathology.  As  summer  comes  on,  the  greater  implica 
tion  of  the  hepatic  organs  changes  the  name,  or  adds  an  epithet  to 
designate  a  prominent  symptom.  In  autumn, '  the  chylopoietic 
viscera  become  more  strikingly  involved  in  the  diseased  action,  and 
this  again  is  indicated  by  an  ever-changing  nomenclature.  But  when 
winter  approaches,  and  the  subjects  are  exposed  to  sudden  transi 
tions  of  temperature,  the  thoracic  viscera  are  called  upon  to  bear 
the  burden  of  local  disease,  and  then  it  is  that  the  names  pleurisy, 
pneumonia,  pneumonia  typhoides,  pneumonia  biliosa, ,  pleuro-pneu- 
monia,  bilious  pleurisy,  lung  ffever,  etc.,  become- familiar." 

After  a  pointed  allusion  to  writers  of  books  On  4jie  practice  of 
medicine,  and  teachers  who  "  find  a  complicated  sjfctem  of  noso 
logy  a  very  convenient  loop  upon  which  to  hang  their  learned  dis 
quisitions;"  as  well  as  to  physicians  in  practice,  who  "derive  advan 
tage  from  an  exercise  of  ingenuity  and  tact,  in  suiting  the  names  of 
prevailing  diseases  to  the  phases  of  popular  prejudice,  and  in  ex 
plaining  their  want  of  success,  without  implicating  the  infallibility 
of  their  skill ;"  and  also  to  the  erudition  displayed  in  arranging  the 
nosology  of  "Southern  fever  into  forty  or  fifty  different  varieties, 
deriving  a  technical  name  for  each  of  them,  from  the  classical  lore 
of  the  schools,  and  from  the  more  vulgar  vernacular  of  modern 
tongues,"  etc.,  Dr.  M.  adds:  "Let  us  talk  as  learnedly,  and  refine, 
discriminate,  and  vary  our  nomenclature  as  we  may,  to  suit  the 
fashion  of  the  times,  when  we  come  to  deal  with  plain  facts,  as  they 
are  presented  to  us  in  practice,  this  whole  class  of  diseases  to  which 
I  have  here  alluded  will  be  found  to  take  its  appropriate  place 
under  the  plain  designation — periodic  fever.  We  know  very  little 
of  the  causes  which  produce  it ;  but  we  meet  with  it  every  month  of 
the  year,  and  generally  it  varies  in  appearance  and  symptoms  only 
as  it  varies  in  degree  of  violence,  and  as  the  different  organs  of  the 
body  become  more  or  less  implicated.  Now  it  so  happens,  and  we 
need  not  attempt  here  to  give  the  reasons  why,  that  the  stomach 
and  brain  become  more  involved  in  the  diseased  action  in  summer, 
and  the  lungs  and  the  other  thoracic  contents,  in  winter."  "These 
local  affections,  whichever  may  for  the  time  predominate,  do  not,  in 
any  material  respect,  change  the  character  of  the  constitutional  dis- 


AUTUMNAL   FEVERS.  49 

ease,  it  is  a  periodic  fever  still,  and  requires  the  anti-periodic  treat 
ment."  "In  all  its  forms  and  modifications,  we  can  never  lose  sight 
of  the  important  fact  that  the  disease  is  one  of  periodicity  and  self- 
limitation.  Its  uniform  paroxysmal  character  points  to  the  use  of 
one  great  remedy,  upon  which,  in  all  cases,  whenever  (wherever?) 
the  local  lesion  may  appear,  we  must  place  our  main  dependence 
for  relief,"  care  being  taken,  however,  to  remove  those  lesions  by 
appropriate  means. 

All  this  is  plain  enough,  and  leaves  no  doubt  as  to  the  import  of 
the  views  under  examination,  of  the  principal  grounds  on  which 
they  are  founded,  and  of  the  mode  of  practice  to  which  they  are 
intended  to  lead.  Pneumonia  must,  henceforward,  be  classed  among 
the  various  diseases'  which,  from  a  peculiar  phenomenon  they  exhibit, 
and  the  peculiar  treatment  they  call  fbr,  take  their  appropriate  place 
under  the  plaift  designation;of  periodic  fever.  Pathologists,  opening 
their  eyes  to  tie  light  once  more  shed  upon  the  subject,  must  cease 
to  consider  pneumonia,  except  in  &few  cases,  as  an  idiopathic  disease 
separate  from  and  independent  of  all  others.  They  must  learn  to 
view  it  as  only  a  form  of  another  complaint;  in  other  words,  as  a 
periodic  fever  in  disguise.  Its  occurrence  at  the  same  time,  and 
in  the  same  place  with  periodic  fevers ;  its  succeeding  to  or  pre 
ceding  these ;  its  presenting  periods  of  exacerbation  and  remission, 
and  its  being  benefited,,  when  these  fluctuations  occur,  by  remedies, 
quinia  particularly,  which  exercise  an  anti-periodic  power,  establish 
beyond  the  possibility  of  doubt  the  important  fact  of  the  close  alli 
ance  between,  if  not  common  origin  of,  those  diseases.  All  the 
diseases  so  classed,  pneumonia,  pleurisy,  pneumonia  typhoides, 
pneumonia  biliosa,  as  indeed,  hepatitis,  phrenitis,  gastritis,  are  pro 
ducts  of  the  same  causes  that  occasion  remittent,  intermittent,  yel 
low  fevers,  plague,  Asiatic  cholera,  and  typhoid  fever — the  difference 
depending  on  temperature,  atmospheric  vicissitudes,  and  the  like.1 

1  In  former  publications, '  Dr.  Merrill  has  expressed  the  opinion  that  yellow  fever 
differs  in  nothing  but  degree  of  violence  from  the  common  autumnal  remittent, 
and  arises  from  precisely  the  same  causes.  I  need  scarcely  remark  that  many  others, 
in  this  country  and  elsewhere,  have  entertained,  and  continue  to  entertain,  similar 
views  on  the  subject.  For  this  reason,  and  because,  while  discarding  all  such  opinions 
relative  to  the  pathological  and  etiological  unity  of  these  two  forms  of  fevers,  I  regard 
yellow  fever,  as  also  common  autumnal  fevers,  as  the  products  of  aerial  poisons — the 


1  "Yellow  Fever  of  Natchez,"  in  1823,  Philadelphia  Med.  and  Phys.  Journ.  ix.  235;  "Yellow  Fever  of 
Natchez,"  in  1825,  A".  A.  Med  and  Surg.  Journ.  ii.  217. 


50  PNEUMONIA    AND 

Autumnal  fever — it  is  argued — being  met  with  every  month  of 
the  year,  the  cause,  whatever  it  may  be,  must  exist  all  the  year 
round,  uninfluenced,  in  regard  to  its  creation  or  disappearance,  by 
changes  of  season,  atmospheric  phenomena,  etc.  Like  every  other 
form  of  fever,  pneumonia  must  be  viewed  as  a  general  disease  of 
the  whole  system,  but  evincing  a  strong  determination  of  diseased 
action  to  some  particular  organ — in  the  instance  before  us,  to  the 
lungs — the  difference  depending  on  season,  weather,  and  other  kin 
dred  circumstances.  Thes$  local  affections,  whichever  may  for  the 
time  predominate,  do  not,  in  any  material  respect,  change  the  cha 
racter  of  the  constitutional  disease — it  is  a  periodical  disease  still, 
and  requires  the  anti-periodic  treatment.  The  pneumonia  of  all 
writers  is,  strictly  speaking,  only  the  pneumonic  form  of  periodic 
fever ;  and  while  we  are  devoting  our  .best  skill  and  energy  to 
relieve  the  local  affection,  we  must  not  lose  sight  of  the  fact  that 
we  are  dealing  with  a  constitutional  complaint — a  periodic  fever. 
Though  it  cannot  be  denied  that  pneumo^a  sometimes  appears 
among  us,  as  an  idiopathic  affection,  we  are  justified  in  concluding 
that  the  thoracic  inflammations,  which  show  themselves  in  this 
country  generally,  sometimes  sporadically,  and  frequently  with  epi 
demic  violence,  are  really  and  substantially  nothing  more  than  a 
peculiar  form  of  intermittent  and  remittent  fever.  In  a  word,  pe- 

results  of  local  infection — of  kindred  though  not  identical  nature,  I  shall,  throughout 
these  pages,  treat  of  them  all  under  the  generic  name  of  malarial  diseases.  They  all 
belong  to  that  family  of  zymotic  diseases  (those  due  to  morbific  ferments),  which, 
unlike  others  of  the  same  class,  which  are  due  to  contagious  viruses,  arise  from  local 
sources  of  infection ;  in  other  words,  in  which  the  morbific  emanations  in  connection 
with  which  they  arise,  act  not  only  as  predisposing,  but  as  exciting  causes  also.  The 
admission  that  these  diseases  belong  to  the  one  class  of  zymotics  and  arise  from  fer 
ments,  by  no  means  necessarily  carries  along  with  it  the  idea  of  pathological  identity. 

For  similar  reasons  I  may  occasionally  refer  to  typhoid  fever  in  connection  with  the 
cause  of  the  former,  for  that  disease  would  appear  to  arise,  sometimes  at  least,  from, 
or  to  be  associated  in  its  production  or  propagation  with,  morbid  agencies  somewhat 
allied  to  those  from  which  autumnal  fevers  generally  spring.  Besides  it  is  viewed, 
with  what  degree  of  propriety  I  shall  not  stop  here  to  inquire,  by  some  of  our  South 
ern  physicians,  to  say  nothing  of  some  few  in  the  North,  and  a  small  set  in  England, 
as  only  a  peculiar  form — the  continued — of  common  autumnal  fevers,  and  not  as  a 
special  and  specific  disease. 

Finally,  I  shall,  for  the  same  reason,  refer  to  the  oriental  plague  as  a  malarial  dis 
ease  ;  for  it  is  not  unusually  acknowledged,  by  high  authorities  too,  to  arise  or  to  be 
greatly  under  the  influences  of  exhalations  of  a  malarial  character;  and  is,  besides, 
regarded  by  some  writers  of  this  country  more  particularly  as  another  form  of  common 
remittent  autumnal  fevers. 


AUTUMNAL   FEVERS.  51 

riodie  fever  is  a  protean  disease,  which  sometimes,  owing  to  sundry 
adventitious  circumstances,  attacks  one  set  of  organs,  sometimes 
another.     When  it  exercises  its  deleterious  influence  on  the  pul 
monary  organs,  it  gives  rise  to  their  inflammation  or  congestion, 
and  occasions  the  disease  we  denominate  pneumonia,  pleurisy,  etc. 
But,  whatever  be  the  part  affected  by  it,  it  is  always  the  same  con 
stitutional  disease,  and  invariably  calls  for  the  same  general  treat 
ment.    Medical  writers  and  medical  teachers  may  amuse  themselves 
in  classifying  diseases  according  to  their  supposed  differences  in 
regard  to  seat,  phenomena,  and  nature ;  they  may  exercise  their  in 
genuity  and  tact  in  suiting  the  names  of  prevailing  diseases  to  the 
phases  of  popular  prejudice ;  or  display  vast  erudition  in  discrimi 
nating  the  different  varieties  of  southern  fevers,  and  arranging  their 
nosology;  they  'may  prate  about  these  matters  as  much  as  they 
please,  but,  by  so  doing,  they  only  afford  the  proof  that  they  have 
not  carefully  imbued' themselves  with  the  principles  of  the  Baconian 
philosophy,  and  that  tBeir  whole  system,  of  the  pathology,  practice, 
etiology  and  physiology  of  fevers  and  febrile  affection  is  erroneous 
— founded  on  preconceived  notions,  and  not  upon  facts  and  induc 
tions.     For  it  is  now  proved,  to  the  satisfaction  of  a  few  observers, 
more  sharp-sighted  than  the  very  large  majority  of  their  brethren 
in  both  hemispheres,  that  this  whole  class  of  diseases  takes  its  ap 
propriate  place  under  the  plain  designation,  periodic  fever  ;  that  all 
the  varieties  of  that  class,  which,  for  certain  reasons,  well  known  to 
the  reader,  have  been  held,  heretofore,  as  distinct  from  each  other — 
typhus,  typhoid,  intermittent,  remittent,  yellow,  etc.  —  are  really 
and  substantially  one  and  the  same  disease,  and  that  in  the  same 
category  must  now  be  placed  pneumonia,  pleurisy,  etc. 

Such  are  the  views  entertained  to  some  extent  in  former  days, 
and  revived  on  a  rather  more  extensive  scale  in  recent  times,  rela 
tively  to  the  close  affinity  or  the  identity — pathological  and  etio- 
logical — of  two  classes  of  diseases  which  the  profession  generally, 
both  here  and  elsewhere,  have  found  ample  reason  to  regard  as 
totally  distinct  from,  and  independent  of  each  other.  Examined 
in  whatever  point  of  view  we  please,  analyzed  as  closely  and 
minutely  as  it  is  in  our  power  to  do,  the  whole  argument  in 
favour  of  those  views — setting  aside  what  flows  from  the  peculiar 
theoretical  notions  of  some  of  their  advocates  relative  to  the  unity 
or  relationship  of  all  diseases — and  stripping  it  of  all  the  hors  d'oeuvres, 
and  hypothetical  assumptions,  and  doubtful  assertions  by  which  it  is 


52  PNEUMONIA    AND 

accompanied,  and  to  a  great  extent  disfigured,  the  opinion  in  ques 
tion  resolves  itself  always  into  a  very  narrow  compass,  and  is  found 
to  rest  on  a  few  points  already  referred  to.  It  may  be  stated  thus: 
the  two  classes  of  diseases,  pneumonia  and  autumnal  or  periodic 
fevers,  prevail  either  simultaneously  or  consecutively  in  the  same 
locality — conclusion :  they  must  be  due  to  the  operation  of  the  same 
causes,  and  therefore  are  identical  in  nature.  The  periodic  element 
is  more  or  less  strongly  marked  in  the  various  grades  of  autumnal 
fevers;  the  same  element  is  sometimes  detected  in  pneumonia — con 
clusion  :  the  latter  disease — to  say  nothing  of  many  others  of  the 
same  class — whether  it  shows  itself  sporadically  or  epidemically,  is 
really  and  substantially  nothing  more  than  a^eculiar  form  of  remit 
tent  and  intermittent  fever.  Pneumonia  soi^etimes  yields  to  the 
action  of  the  same  remedies  which  are  four#i  to  check  the  course  of 
autumnal  or  periodic  fevers — conclusion :  thfi  similarity  of  results 
obtained  from  the  same  treatment  in  both  clashes  of  diseases,  implies 
a  close  alliance  between  them,  or,  indeed^.,  a  .common  origin  and 
pathological  identity.  Pneumtrtiia  must  be  viewed  as  a  general 
disease  of  the  whole  system,  but  evincing  a  determination  of  morbid 
action  to  the  lungs;  the  same  may  be  said  of  autumnal  fevers, 
with  the  exception  that  the  local  determination  t$kes  place  in  some 
other  part — conclusion :  both  these  classes  of  diseases  being  consti 
tutional,  and  the  difference  of  the  local  effects  depending  on  fortui 
tous  and  secondary  circumstances,  they^are.  produced  by  the  same 
causes,  and  are  identical  in  nature. 

It  is  evident,  from  what  precedes,  that  the  ,Kip&erii  advocates  of 
the  theory,  or  rather  hypothesis  in  question',  for  it  scarcely  de 
serves  the  name  of  theory,  may  fortify  their  cause  by  an  appeal  to 
the  imposing  phalanx  of  authorities  above  referred  to.  ISTo  one 
will  deny  that  among  these  several  are  found  who  are  entitled, 
for  many  reasons,  to  the  unbounded  regard  of  the  profession  at 
large,  and  are  destined  to  occupy  an  honourable  position  in  the 
annals  of  our  science.  Neither  can  we  doubt  that  others  among 
them — perhaps  a  large  number — deserve  to  be  treated  with  courtesy, 
manifesting,  as  they  generally  do,  practical  good  sense,  a  commend 
able  amount  of  professional  attainments,  and  no  inconsiderable  share 
of  ingenuity  and  smartness.  But  however  numerous  the  advocates 
of  the  hypothesis  undoubtedly  are,  and  whatever  may  be  the  degree 
of  respect  to  which  their  opinions  on  this  and  other  subjects  is  enti 
tled,  it  need  scarcely  be  observed  that,  in  what  has  been  adduced 


AUTUMNAL    FEVERS.  53 

in  its  support  by  them,  we  cannot  discover  sufficient  reason  to  acqui 
esce  in  .its  correctness ;  while  the  circumstances  under  which  some 
of  the  writers  quoted  were  placed,  and  the  opportunity  for  accurate 
observation  and  close  and  careful  induction,  and  the  degree  of  pro 
fessional  scholarship  possessed  by  others,  were  not  such  as  to  ren 
der  their  verdict  on  pathological  and  etiological  points  beyond  the 
reach  of  criticism,  and  to  silence  opposition  on  the  part  of  sub 
sequent  inquirers.  Some,  and  perhaps  the  most  distinguished, 
flourished  at  a  time  when  pathological  and  etiological  knowledge 
was  at  too  low  an  ebb  to^  induce  us  to  look  to  them  for  the  settle 
ment  of  questions  of  the  kind.  Others,  though  living  at  a  period' 
less  remote  from  our  ^>wn,  do  not  appear  to  have  sufficiently  quali 
fied  themselves  -by  diligent  inquiry,  and  extensive  and  close  study, 
to  justify  their  pretensfejis  to  enlighten  the  medical  world  on  sub 
jects  of  this  nature;  %hile  others,  again,  who  recently  have  thought 
fit  to  revive  the  hypothesis;  have  evidently  taken  but  a  one-sided 
and  contracted  view  of  the  matter,  and  allowed  themselves  some 
times  to  be  swayed  in  their  infe*r%nces  by  favourite  and  fanciful 
hobbies. 

Under  such  circumstances  the  subject  might,  and  perhaps  ought 
to  have  been  allowed  to  drop.  But  the  importance  of  the  question 
thus  raised ;  the  stir  it  has  occasioned  among  the  physicians  of  some 
sections  of  this  country,  and  the  fair  professional  standing  of  some 
of  its  modern  supporters,  bave  induced  me  to  investigate  it  with  all 
the  care  and  attention  of  which  I  am  capable.  The  result  of  this 
investigation  hasten  unfavourable;  and  so  far  from  leading  me  to 
lend  a  willing  ear  to  the  connection  under  consideration,  has  only 
tended  to  confirm  me  in  the  opinion  I  have  always  held  on  the  sub 
ject.  It  has  done  more ;  for  I  have  thereby  been  induced  to  adopt 
conclusions  diametrically  adverse  to  those  of  which  I  have  pre 
sented  an  outline.  Now,  more  than  ever,  I  regard  these  as  faulty 
in  a  scientific  point  of  view,  and  leading  to  pathological  deductions 
not  only  erroneous  and  at  variance  with  long  admitted  principles, 
but  occasionally  glaringly  illogical.  I  hold  them  to  be  in  direct 
opposition  to  facts  which  are,  or  ought  to  be  familiar  to  every  ob 
servant  and  well-read  physician.  I  hold  them  to  evince  a  total 
oversight  of  all  established  opinions  respecting  the  causes  of  the 
several  diseases  thus  placed  in  juxtaposition.  I  hold  also  that,  how 
ever  plausible  these  conclusions  may  seem  to  be,  they  have  not  been 
supported,  as  far  as  I  can  perceive,  by  a  single  fact  or  argument 


54  PNEUMONIA    AND 

calculated,  when  properly  sifted,  to  satisfy  a  careful  inquirer,  and 
to  which  a  ready  answer  may  not  be  found.  I  hold  all  this ;  and 
see,  with  regret,  that  the  whole  subject  has  been  presented  in  a  man 
ner  evincing  a  decided  disposition  to  set  at  naught,  as  worthless, 
the  observations  and  inferences  of  all  preceding  and  contemporary 
writers  who  entertain  adverse  views,  and  not  unfrequently  in  a  tren 
chant  and  contemptuous  tone,  from  which  none,  not  even  those 
whom  the  medical  world  has  never  ceased  to  treat  with  courtesy, 
and  view  in  the  light  of  standard  authorities,  are  allowed  to  escape. 
For  these  reasons,  and  considering  also  that  these  opinion's  are  likely 
to  lead,  if  adopted  and  acted  upon,  especially  by  inexperienced 
physicians,  to  a  hazardous  practice  ;  bearing  in  r#ind,  besides,  that, 
from  the  influential  position  which  some  of  their  advocates  occupy, 
there  is  reason  to  fear  they  may  continue  to  maj$e  converts,  not 
only  among  medical  students,  but  among  -that  cl^jss  of  professional 
readers — unfortunately  too  large  among  us — who  are  easily  seduced 
by  real  or  supposed  novelties,  and  fanciful  or  whimsical  notions  ;  and 
convinced,  in  addition,  of  the  necessity  of  ascertaining,  without  loss 
of  time,  the  value  of  dogmas  bearing  directly  or  indirectly  on  prac 
tical  points,  when  presented  and  enforced  by  men  of  note  and  repu 
tation,  I  propose  to  devote  this  volume  to  a  survey  of  the  facts  and 
arguments  that  may  be  adduced,  and  thus  to  test,  in  its  various 
details,  the  hypothesis  to  which  attention  has  been  called,  and  see 
how  far  it  is  deserving  of  our  adoption. 

The  reader  will  easily  perceive  that,  bcf<3&  the  advocates  of  the 
identity  of  the  two  diseases  can  successfully  sustain  the  position 
they  have  assumed,  it  will  be  necessary  for  them  to  show  that  au 
tumnal  fevers  and  pneumonia  are  produced  by  the  same  causes ; 
that  they  prevail  in  the  same  places,  and  during  the  same  seasons 
of  the  year ;  that  their  existence  and  diffusion  are  promoted  by  the 
same  agencies ;  that  they  are  arrested  by  similar  means ;  that  they 
exercise  their  effects  on  the  same  classes  of  individuals ;  that  they 
present  similar  or  kindred  symptoms;  that  they  affect  the  same 
organs,  and  produce  the  same  or  analogous  changes  in  the  fluids 
and  soli  Jrf  ;  that  they  are  governed  by  the  same  laws  ;  and  that  they 
present  other  points  of  approximation  invariably  found  to  be  pos 
sessed  by  diseases  between  which  there  exists  the  close  connection 
claimed  in  the  instance  before  us.  Unless  they  can  succeed  in 
attaining  these  objects,  their  opinion  must  fall,  and  the  independence 
of  those  diseases  be  admitted.  It  becomes  necessary,  therefore, 


AUTUMNAL   FEVERS.  55 

to  take  up  each  of  those  subjects  separately,  and  to  ascertain  how 
far  they  may  be  appealed  to  in  respect  to  the  question  at  issue. 

As  we  have  seen,  it  is  admitted  that  pneumonia  is  sometimes  an 
idiopathic  affection,  caused,  of  course,  in  such  cases,  by  atmospheric 
vicissitudes,  or  other  kindred  morbid  influences,  and  unconnected 
with  any  complaint  except  ordinary  phlegmasise.  But,  while  admit 
ting  thus  much,  it  is  contended  that,  in  the  majority  of  instances, 
the  disease  must  be  referred  to  a  different  origin,  and  viewed  as 
simply  symptomatic ;  that  it  is  a  mere  form  of  another  complaint, 
and  would  not,  it  may  b£  presumed,  exist  if  the  causes  of  the  latter, 
whatever  they  may  be,  did  not  exercise  their  baneful  influence.  It 
is  suggested  that  t lie  combination  of  phenomena,  which  impressed 
the  common  observer  with  the  idea  that  he  beheld  a  special  and  in 
dependent  complaint,  was  -  fallacious — really  nothing  more  than  a 
cloak,  serving  t(y'*disgufee  a  disease  which,  in  its  natural  state, 
assumes  a  different  dress;  and  that,  while  with  infantile  simplicity 
we  fancied  we  had  before  us  a  disease  of  well-known  pathological 
character,  it  turns  out  that  we  were  dealing  with  one  of  a  totally 
different  kind,  in  which  the  affection  of  the  lungs  constituted  an 
accidental  and  unessential  element. 

All  this  may  prove  acceptable  in  certain  quarters;  it  may  be 
regarded  as  plausible  by  some,  or  even  as  well  founded  and  per 
fectly  unanswerable.  But,  so  far  as  I  am  concerned,  I  have  no 
hesitation  in  stating,  as  the  result  of  my  personal  observations,  aided 
by  extensive  inquiry -^hd  close  reflection,  that  pneumonia  is  not 
sometimes  but  always  an  idiopathic  disease,  whether  it  occurs  spo 
radically  or  epidemically;  whether  in  the  South,  in  the  North,  in 
the  East,  or  in  the  West;  whether  in  fever  districts,  or  in  fever 
seasons,  or  in  places  or  at  periods  of  the  year  free  from  periodical 
fevers;  and  that  it  is  due  to  causes  perfectly  distinct  from  those  to 
which  such  fevers  owe  their  origin.  I  believe  this;  and  believe, 
besides,  that  even  were  pneumonia  produced  at  times  by  the  legiti 
mate  causes  of  fevers,  such  cases  would  not  be  any  more  symptomatic 
than  those  that  are  due  to  the  ordinary  causes  of  the  disease  ;  for 
these  do  not  act  directly  and  primarily  on  the  lungs  any  more  than 
the  others  would  do,  supposing  them  capable  of  giving  rise  to  the 
effect  in  question.  And  as  in  either  circumstance  the  primary  im 
pression  is  received  by  some  other  part  of  the  system,  and  thence 
reflected  on  the  pulmonary  organs,  the  two  sorts  of  cases  must  be 
placed  on  the  same  footing,  arid  be  all  primary  or  all  secondary.  Of 


56  PNEUMONIA    AND 

course  we  must  exclude  from  the  cases  thus  referred  to,  those  pro 
duced  by  traumatic  or  mechanical  injuries,  and  agencies  acting 
directly  on  the  lungs,  for  these  might,  strictly  speaking,  be  called 
symptomatic.  It  may,  perhaps,  also  be  proper  to  exclude  some  of 
those  in  which  symptoms  of  pneumonia  show  themselves  during  the 
progress  of  other  diseases,  or  after  extensive  surgical  operations  or 
wounds.  I  say  in  some,  for  while  in  these  the  inflammation  of  the 
lungs  is  secondary,  and  merely  the  effect  of  sympathetic  irritations, 
which  may  and  do  arise  in  a  variety  of  dissimilar  complaints,  and  are 
somewhat  influenced  by  the  nature  of  the  cause  giving  rise  to  them; 
in  others,  the  pneumonia  may  properly  be  called  ifliopathic,  inas 
much  as  it  is  independent  for  its  causation  of  the  agency  giving  rise 
to  the  prior  complaint,  being  produced  by  the  same  causes  which 
would  have  given  rise  to  it  had  no  such  disease,  operation,  or  wound 
preceded.  But,  whatever  be  the  mode  of  origin  of  suck  cases,  many 
of  which  properly  belong  to  a  category  to  which  attention  will  be 
called  by  and  by,  it  may  safely  be  maintained  that  pneumonia,  when 
ever  it  shows  itself  ab  initio,  is  idiopathic,  that  it  is  always  produced 
by  its  appropriate  causes,  and,  what  is  more  to  our  present  purpose, 
that  it  is  independent  for  its  origin  of  those  morbid  agencies  to  which 
autumnal  fevers  are  due ;  that  it  is  not  less  independent  of  such 
fevers  in  a  pathological  point  of  view,  and  that  it  cannot,  therefore, 
be  lowered  to  the  rank  of  a  peculiar  form  of  that  class  of  diseases. 

1.  Pneumonia  common  where  fevers  seldom  or  never  are  seen. — It  is 
scarcely  necessary  to  remark  that  inflammatory  affections  of  the 
substance,  and  lining,  and  covering  membranes  of  the  lungs,  prevail 
very  extensively  in  places  where  remittent,  intermittent,  and  other 
fevers  of  kindred  nature  are  not  observed,  and  during  seasons  of  the 
year  when,  if  the  ordinary  causes  of  fever  had  at  any  time  exercised 
their  influence,  they  have  been  effectually  or  temporarily  checked. 
With  us,  pneumonia  prevails,  during  certain  periods  of  the  year,  in 
localities  where  autumnal  fevers,  especially  intermittents,  rarely  if 
ever  originate.  In  Philadelphia — and  the  same  may  be  said  of 
other  large  cities — such  a  thing  as  a  case  of  the  latter  disease  is 
seldom  encountered.  When  the  disease  does  present  itself,  it  is 
usually  seen  among  individuals  who  have  taken  it  elsewhere.  On 
the  other  hand,  in  our  extreme  suburbs  and  in  the  surrounding 
open  country,  where  remittents  and  intermittents  are  sometimes 
quite  rife,  and  always,  except  in  winter,  more  or  less  noticed,  pneu- 


AUTUMNAL    FEVERS.  57 

monia  is  not  much  more  common  than  we  find  it  to  be  in  the  city 
proper;  not  more  so,  at  least,  than  can  be  accounted  for  by  the 
greater  exposure  of  the  inhabitants  to  atmospheric  vicissitudes  and 
other  known  causes  of  the  disease.  Within  the  limits  of  the  bills 
of  mortality,  including  the  city  proper,  where  periodic  fevers  are 
scarcely  ever  seen,  and  a  few  only  of  the  fever  districts,  the  propor 
tion  of  deaths  from  inflammation  of  the  lungs  and  bronchire,  in 
thirteen  years,  1836-1848,  amounted  to  1  in  11.7.1  Again,  in  the 
cities  of  our  Middle  States,  the  yellow  fever,  which,  as  we  have 
seen,  approximates  to,  without  however  being  identical  with,  ordi 
nary  autumnal  fevers,  shows  itself  only  in  certain  confined  and 
peculiarly  circumstanced  localities,  especially  along  and  near  the 
wharves.  Now 'if  there  are  facts  to  show  that  pneumonia  is  more 
common  in  such  localities,  during  sickly  seasons  or  at  any  other 
time,  than  ii*  other  places  where  the  fever  never  reaches,  unless 
imported,  an  experience  of  upward  of  thirty  years  has  not  enabled 
me  to  discover  them,  and  I  am  sure  no  one  has  been  more  fortunate 
than  myself  on*  that  score.  Most  American  medical  readers  know, 
or  if  they  do  not,  a  perusal,  among  others,  of  Dr.  Holmes's  excel 
lent  Dissertation  on  Intermittent  Fevers  will  teach  them,  that  this 
disease  is  of  rare  occurrence  in  New  England,  except  in  certain 
circumscribed  localities  to  be  noticed  by  and  by,  and  that  it  has 
disappeared  in  places  where  some  years  ago  it  prevailed  more  or  less 
extensively.  It  may  be  remarked,  also,  that  in  other  localities  of  this 
country,  and  in  various  cities  and  rural  districts  of  France,  England, 
Tuscany,  Lucca,  and  other  parts  of  Europe,  to  which  I  shall  have 
occasion  to  call  attention  as  I  proceed,  inter mittents,  which  before 
had  spread  extensively,  have  so  effectually  been  chased  away,  by 
the  judicious  application  of  hygienic  means,  as  to  be  now  but  rarely 
encountered.  But  while  such  has  been  the  case  with  regard  to 
malarial  fevers,  we  are  perfectly  safe  in  affirming  that  pneumonias 
have  not  disappeared  together  with  the  former  from  any  of  those 
spots  of  New  England,  which  have  so  much  improved  in  point  of 
salubrity;  that  the  disease  prevails  over  the  whole  region  now  as  it 
did  formerly,  and  that  hence  there  are  few  physicians  better  ac 
quainted  with  its  phenomena  than  our  brethren  of  the  Eastern 
States.  Among  our  troops  in  the  military  posts  on  the  coast  of 
New  England,  the  ratio  treated  per  thousand  of  mean  strength, 

1  Trans,  of  Coll.  of  Pliys.  ii.  375. 


58  PNEUMONIA    AND 

amounts,  according  to  Forry,  to  41.1  On  a  mean  strength  of  3,138, 
there  were  233  cases  of  catarrh  and  influenza,  22  of  pneumonia,  and 
26  of  pleurisy.2 

Nor  is  it  less  certain  that  the  same  remarks  are  applicable  to 
the  localities  in  Europe  above  referred  to;  for  there  pneumonias 
continue  to  prevail  as  extensively  and  fatally  as  when  their  insa 
lubrity  from  malarious  influences  was  most  noted.  Take  Paris 
and  London  as  examples.  According  to  Dr.  Lombard,  pneumonia 
constitutes,  in  the  former,  one-fourteenth*  part  of  the  diseases  of 
adult  subjects,  while  in  children  the  proportion  varies  from  one- 
fourth  to  one-fifth.3  The  correctness  of  this  estimate  is  confirmed, 
so  far  as  regards  adults,  by  the  results,  obtained  by  Grisolle,  who,  on 
comparing,  during  three  years,  the  frequency  of  that  disease,  rela 
tively  to  that  of  all  other  internal  complaints,  in  the  hospitals  of  that 
city,  found  that  the  former  constituted  the  fourteenth,  fifteenth,  or 
seventeenth  part  of  acute  and  chronic  complaints.  In  asylums  for  old 
people,  the  average  proportion  of  pneumonias  .appears  to  vary  from 
one-sixth  to  one-seventh.4  To  thfe  it  may  bemadded,  as  corroborative 
of  the  extreme  frequency  of  pneumonia  in  Paris,  that  the  average 
mortality  in  the  ten  years,  1837-1848,  from  pulmonary  catarrh, 
amounted  to  2,222,  and  that  from  pneumonia  to  2,037.5  I  arn  aware 
that  a  contrary  statement  has  been  made  in  regard  to  London  and 
other  parts  of  England.  Dr.  Wells,  as  ^fcfehSve  seen,  insists  on  the 
decrease  of  thoracic  inflammation  in  that  city  since  the  diminished 
prevalence  of  malarial  fevers,  and  appeals  t$>  other  physicians  for 
the  occurrence  of  a  similar  result  elsewhere.  A  Mr.  Weeks,  of 
Sussex,  informed  him  that  genuine  pleurisies  were  not  seen  there 
now  as  formerly.  Dr.  Wells  farther  refers  to  Dr.  Harrison,  of  Horn- 
castle,  who  mentions  incidentally,  in  different  parts  of  An  Essay  on 
the  Rot  in  Sheep,  that  both  agues  and  acute  inflammation  of  the 
lungs  are  less  common  in  Leicestershire  than  they  used  to  be.  "Ac 
cording  to  Sydenham,"  Dr.  Wells  continues,  "  no  disease  was  in  his 
time  more  frequent  than  pleurisy.  At  present,  a  physician  in  con 
siderable  practice  here  may  pass  several  years  without  seeing  a 
single  legitimate  instance  of  it."  Dr.  Wells,  it  is  true,  finds  that  Dr. 
Willan,  in  his  Report  on  the  Diseases  in  London,  from  1796  to  1800, 
makes  frequent  mention  of  thoracic  inflammations ;  but  he  believes 

1  Forry;   Climate  of  U.  S.  238.  2  Ibid.  242. 

3  Archives  Gen.  de  Medecine,  xxv.  68.  4  Traite  dc  la  Pneumonic,  127. 

5  Trebuchet;  Ann.  d'llygil-ne,  xlvi.  20. 


AUTUMNAL   FEVERS.  59 

that  that  eminent  physician  must  have  called  diseases  by  the  name 
of  pleurisy  which  differed  considerably,  in  regard  to  the  mode  of 
treatment  they  required,  from  the  same  complaint  referred  to  by 
Sydenham ;  and  closes  with  the  remark  that  the  instances  of  acute 
inflammation  of  the  contents  of  the  chest  which  fell  under  his  ob 
servation,  in  London,  were  almost  solely  peripneumonias,  in  which 
copious  bleeding  was  less  clearly  indicated,  and  was  attended  with 
less  benefit  than  commonly  happens  in  pleurisies ;  and  one-half,  per 
haps,  of  these  instances,  %hich  were  not  numerous,  supervened  to 
acute  rheumatism.1 

Without  stopping  to  examine  how  far  the  reasons  assigned  by  Dr. 
Wells  for  doubting  the  frequency  of  thoracic  inflammation  in  London 
are  correct,  and  without  denying  the  possibility  of  the  decrease  of 
pleurisy  in  Sussex  or  Horncastle,  I  may  remark  that  the  statements 
of  eminent  writers  ^hcl  statisticians  do  not  bear  that  physician  out 
in  his  conclusions.  According  to  Dr.  Farr,  who  has  devoted  much 
attention  to  the  subject,2  while  in  all.  England  the  mortality  from 
pneumonia  amounted  in  1838  to  a^Dout  one  twenty -fifth  part  of  the 
whole  number  of  deaths,  and  to  about  one-twentieth  of  those  from  in 
ternal  diseasespn  London  the  proportion  amounted  to  about  one- 
fifteenth  of  the  whole  deaths,  and  one-thirteenth  of  those  from 
internal  complaints.*  In  London,  the  average  deaths  from  1820  to 
1831,  inclusive,  occasip&lj&foy  inflammation  of  the  lungs  and  pleu 
risy,  amounted  to  2,077.3  vln  1839,  while  the  deaths  from  those  dis 
eases  in  England  and  Wales  amounted  to  one  in  18.01  of  the  mor 
tality  from  all  causes  excepting  external  violence,  the  loss  in  London 
was  one  in  one  hundred  and  twenty-nine,  being  3,687  from  pneumo 
nia,  and  sixty-five  from  pleurisy.  In  1840,  the  proportion  did  not 
differ  very  materially  from  this.  Sir  Gilbert  Blane  states  that,  dur 
ing  ten  years'  service  at  St.  Thomas's  Hospital,  he  attended  upwards 
of  320  cases  of  pulmonary  inflammation,  and  192  of  intermittent 
fever.  In  private  practice,  during  another  period  of  ten  years,  1795 
to  1806,  he  attended,  out  of  8,160  cases  of  various  diseases,  145  of 
pulmonic  inflammation,  and  only  twenty-five  of  intermittent.4 

Other  facts  lead  to  the  same  conclusions.     If  we  turn  to  Nova 

1  Transactions  of  a  Society  for  the  Diffusion  of  Med.-Ch.  Knowledge,  iii.  539-541. 

2  W.  Farr,  First  Annual  Report  of  the  Registrar-General  of  Births,  Marriages,  &c. 
London,  1839,  p.  168. 

3  Marshall,  Mortality  of  London,  last  table. 

4  Select  Dissertations,  i.  205-247. 


60  PNEUMONIA    AND 

Scotia,  Malta,  Bermuda,  and  Gibraltar,  and  examine  how  matters 
stand  there  in  relation  to  the  question  before  us,  we  shall  find 
that  malarial  fevers  are  rarely  encountered,  while  both  residents  and 
visitors  suffer  extensively  from  pneumonia.  In  Gibraltar,  Dr.  Hen- 
nen1  states  that  malarial  fevers  seldom  show  themselves,  while  the 
mortality  from  pulmonary  inflammation  is  very  large.2  The  tables 
furnished  by  Major  TiiHock,  show  that,  in  an  aggregate  strength  of 
60,269,  the  admission^  among  the  troops  for  quotidian,  tertian, 
and  remittent  fevers,  amounted  in  nineteen  years,  1819-1836  (ex 
clusive  of  cases  occurring  during  the  yellow  fever  epidemic  of  1828), 
to  616,  and  for  yellow  fever  to  four.  At  the  same  time,  the  number  of 
cases  of  inflammation  of  the  lungs  reached  2,515,  and  of  pleurisy 
twenty-eight,  or  2,543  ;  giving  an  average  of  42.3  per  1,000.3  In 
Malta,  with  a  strength  of  40,826,  trie  admission^  for  periodic  fevers 
(intermittents  and  remittents)  amounted  to  69o,  or  seventeen  per 
1,000 ;  those  for  inflammation  of  the  lungs  to  1,370  ;  and  for  pleu 
risy,  to  twenty-one — total,  1,391.;  or  thirty  per  1,000;4  the  mortality 
being  one-fifteenth  of  the  whole.5  In  Bermuda,  in  an  aggregate 
strength  of  11,721,  those  same  fevers — intermittent  and  remittent — 
amounted  to  forty-six,  and  inflammation  of  the  lungs  and  pleurisy 
to  441,  or  seventeen  per  1,000.  In  Nova.  Scotia  and  New  Bruns 
wick,  malarial  fevers  figure  in  the  tS^|s  $>r  52,  while  inflammation 
of  the  lungs  presents  an  aggregate  of  I,o05,  to  which  must  be 
added  seventy-two  cases  of  pleurisy,  w^ichj  the  strength  being 
44,120,  gives  us  a  proportion  of  thirty-n>e  per  1,000.  It  is  proper 
to  state  that  I  have  excluded,  in  this  comparison,  the  common  con- 

1  Topography  of  the  Mediterranean,  490. 

2  Ibid.  498. 

3  Mortality  of  the  British  Army,  pp.  7-1 1. 

4  At  page  64,  Major  Tullock  states  that,  from  1830  to  1836,  the  aggregate  strength 
at  Gibraltar  being  22,868,  655  cases  of  pneumonia  and  pleurisy  were  admitted,  or 
twenty-nine  per  1,000.     At  Malta,  the  strength  being  15,031,  the  cases  amounted  to 
456,  or  30.3  per  1,000.     At  page  17,  we  have  the  following  table,  which  exhibits  at  a 
glance  those  proportions  in  19  years : — 

Aggregate  strength  Admission 

Pneumonia.  in  20  years.  1'.  and  PI.  Per  1 ,000 

Gibraltar,         ...                  .     60,269  2,543  42 

Malta, 40,826  1,391  34 

Ionia  Island, 70,293  2,272  32 

Bermuda, 11,721  441  37 

Nova  Scotia  and  New  Brunswick,      .     44,120  1,577  35 

5  Mortality  of  the  British  Army,  pp.  22,  23. 


AUTUMNAL    FEVERS.  61 

tinned  fever  mentioned  in  the  reports.  Its  origin  from  the  malaria 
of  common  autumnal  fever  is  doubtful,  and  being  found  to  prevail  in 
the  most  diversified  climates,  it  may  be  viewed  as  the  typhoid  fever 
of  most  modern  writers.  At  Constantine,  in  Africa,  paludal  fevers 
are  not  common,  and,  according  to  Dr.  A^.tonini,  physician  in  chief 
of  the  French  army  of  occupation,  when  they  appeared  among  the 
soldiers,  they  had  most  generally  been  take^p.  elsewhere.  Thoracic 
inflammations,  on  the  contrary,  are  very  frequently  noticed1  in  that 
vicinity.  Pneumonias  are  very  common  in  Chili,  at  all  seasons  of 
the  year,  though  more  particularly  during  the  spring  months.  On 
the  other  hand,  intermittents  and  other  forms  of  malarial  fevers  are 
there  rarely  encountered.2 

The  city  of  Turin,  in  Italy,  is  exempt  from  those  fevers ;  but 
pneumonia  is  of  common  occurrence.3  Similar  observations  have 
been  made  at  Genoa.4  Sweden,  except  in  some  few  of  its  southern 
and  alluvial  districts  is,  like  several  other  northern  countries,  free 
from  malarial  fevers.  But  so  frequently  is  pneumonia  encountered 
there  that,  by  Hoffman,  it  was  viewed  in  the  light  of  an  endemic.5 

2.  Pneumonia  not  necessarily  prevalent  where  fevers  are  common. — 
If  now  we  reverse  the  proposition,  and  inquire  into  the  frequency 
of  pneumonia  in  malarious  an& fever  localities — a  frequency  which 
we  might  reasonably  expeclHl)  occur,  were  the  causes  of  the  dis 
eases  and  their  pathology  the  same — we  shall  find  little  reason 
to  admit  the  corre&nefe-  of  the  hypothesis  under  examination. 
Hippocrates,  it  is  true,  may  be,  and  indeed  has  been,  appealed  to 
in  support  of  the  fact  that  pneumonia  is  of  common  occurrence 
in  paludal  countries;  and  there  is  no  doubt  that  if  his  testimony 
can  avail  in  the  settlement  of  this  matter,  and  be  considered  con 
clusive,  the  advocates  of  the  opinion  in  question  may  congratulate 
themselves,  for  the  language  of  the  Coan  physician  is  explicit: 
"And  I  wish  to  give  an  account  of  the  other  kinds  of  waters, 
namely,  of  such  as  are  wholesome,  and  such  as  are  unwholesome, 
and  what  bad  and  what  good  effects  may  be  derived  from,  water, 
for  water  contributes  much  towards  health.  Such  waters,  then, 

1  Boudin,  Georgia  Med.  80. 

2  Lafargue;  Bulletin  de  1'Academia  de  Medecine,  xvii.  178-203. 

3  Mem.  de  1'Acad.  de  Med.  xiv.  230-1. 

4  Ann.  d'Hyg.  xxx.  58  ;  xxxv.  5  ;  xxxvi.  304. 

5  Williams ;  Cyclop,  of  Pract.  Med.  iii.  408. 


62  PNEUMONIA    AND 

as  are  marshy,  stagnant,  and  belong  to  lakes,  are  necessarily  hot 
in  summer,  thick,  and  have  a  strong  smell,  since  they  have  no 
current ;  but  being  constantly  supplied  by  rain-water,  and  the  sun 
heating  them,  they  necessarily  want  their  proper  colour,  are 
unwholesome,  and  form  bile;  in  winter  they  become  congealed, 
cold,  and  muddy  with  the  snow  and  ice,  so  that  they  are  most  apt 
to  engender  phlegm  and  bring  on  hoarseness;  those  who  drink 
them  have  large  and  obstructed  spleens;  their  bellies  are  hard, 
emaciated,  and  hot ;  and  their  shoulders,  collar-bones,  and  faces  are 
emaciated."  "  This  disease  is  habitual  to  them  both  in  summer  and 
in  winter;  and,  in  addition,  they  are  very  subject  to  dropsies  of  a 
most  fatal  character ;  and,  in  summer,  dysenteries,  diarrhoeas,  and 
protracted  quartans  frequently  seize  them  ;  and  these  diseases,  when 
prolonged,  dispose  such  constitutions  to  dropsies,  and  thus  prove 
fatal.  These  are  the  diseases  which  attkck  them  in  summer ;  but, 
in  winter,  younger  persons  are,  .liable  to  pneumonic  and  maniacal 
affections ;  and  older  persons  to  ardent  fevers  from  hardness  of  the 
belly."1 

In  our  days,  the  statement  has  received,  the  sanction  of  no  less  an 
authority  than  the  great  Joseph  Frank,  from  wj;om  we  learn  that, 
in  the  course  of  an  extensive  practice,  he  never  saw  so  large  a  num 
ber  and  so  great  a  variety  of  pneumonias  as  among  the  peasant 
inhabitants  of  the  rice  fields  of  the  canton  of  Te^sino,  where  paludal 
fevers  are  endemic.2  But  facts  in  abundance  may  be  collected  to 
show  that  though  under  some  circumstances  pneumonia  may  pre 
vail  frequently,  or  even  extensively,  in  local&ies^bject  to  malarial 
fevers — as  the  environs  of  Strasburg,  Pavia,  Padua,  Kome,  Naples, 
the  vicinity  of  Vesuvius,  as  well  as  in  many  parts  of  this  country  will 
attest — it  frequently  happens  that  in  such  localities,  even  where 
the  paludal  cause  exercises  its  baneful  effects  with  great  energy, 
inflammation  of  the  lungs  is  comparatively  rare,  and  in  some 
scarcely  encountered.  Indeed,  there  are  not  wanting  reasons  to 
justify  the  opinion  that,  on  the  point  in  question,  the  father  of  medi 
cine  must  be  regarded  as  an  unsafe  guide,  and  that  his  statement 
should  be  received  with  great  caution.  For,  though  in  the  marshy 
districts  of  Greece,  inflammatory  affections  of  the  lungs  may,  for 
what  we  know,  have  been  frequently  seen  by  him — a  fact  which, 
as  we  shall  see,  recent  observations  do  not  tend  to  confirm — the 

1  Adams's  transl.  i.  195-6  ;  Airs,  Waters,  and  Places ;  Littre's  trans,  ii.  29. 

2  Praxeo's  Med.  ii.  pt.  ii.  315. 


AUTUMNAL   FEVEKS.  63 

cases  so  noticed  were,  probably,  in  most  instances,  nothing  more 
than  severe  catarrhal  affections.  In  saying  this,  I  trust  I  shall  not 
be  considered  as  undervaluing  the  merits  of  this  truly  extraordi 
nary  man ;  but,  whatever  may  have  been  the  remarkable  powers  of 
observation  he  possessed,  it  is  not  to  be  supposed  that  his  diagno- 
stical  proficiency  was  such  as  to  enable  him  invariably  to  discri 
minate  with  accuracy  between  catarrh  and  true  parenchymatous 
inflammation  of  the  lungs. 

Dr.  Forry,  in  his  account  of  the  climate  of  the  United  States, 
remarks  of  pneumonia,  pleurisy,  and  catarrh,  that  they  are  "  inva 
riably  less  prevalent  in  the  moist  and  changeable  climate  peculiar  to 
the  sea-coast  and  large  lakes,  than  in  the  dry  atmosphere  of  the 
opposite  locality-;"1  and  we  all  know  that  it  is  precisely  in  the 
former  localities  that  fever  abounds.  In  the  northern  division,  the 
average  number  of  cases. -of  pneumonia  in  1,000  was  found  to  be 
45  ;  that  of  intermittent  and  remittent  fevers,  231.  In  the  middle 
division,  the  averages  in,'l,000  were  74.5  of  pneumonia,  and  739  of 
fevers ;  and,  in  the  southern  division,  the  average  of  pneumonia  in 
1,000  was  43,  and  of  fevier  5$8.2 

In  the  East  Indies,  where  jungle  and  remittent  fevers  are  com 
mon,  pneumonia.4§f  scarcely  known.  Desportes,  while  quoting  the 
old  aphorism,  cattidum  pectori  amicum,  frigidum  inimicum,  informs 
us  that  the  disease  is  less  frequent  in  St.  Domingo,  one  of  the 
most  malarial  of  the  West  India  Islands,  than  in  France.3 

In  the  Windward  and  Leeward  islands,  as  well  as  in  Jamaica,  where 
sources  of  malariaj&ibokad,  and  where  fevers,  in  consequence,  con 
stitute  near  one-halt  of  the  prevailing  diseases,  pneumonia,  so  far 
from  being  a  common  complaint,  is  rarely  encountered.  In  the 
former  command,  an  average  military  strength  of  4,333,  gave,  in 
twenty  years,  1817-37,  62,163.  Of  these,  24,607  were  quotidians; 
1,973  tertians;  133  quartans;  17,799  remittents,  and  774  yellow 
fever.  This  makes  a  total  of  45,286  malarial  fevers,  the  balance 
being  common  continued  (typhoid  ?),  typhus,  and  synochus.  During 
the  same  period,  inflammation  of  the  lungs  furnished  a  quota  of 
only  1,941,  and  pleurisy  of  34.4  In  the  Jamaica  command,  with 
an  average  military  strength  of  2,578,  the  number  of  fever  cases 
were  no  less  than  46,922,  or  910  per  1,000.  Of  these  cases,  not 

1  Climate  of  the  United  States,  359.  2  Ibid.  233,  277,  284. 

3  Maladies  de  St.  Domingue,  i.  32. 

4  Tullock,  Med.  Statistics  of  Brit.  Army,  7,  8. 


64  PXEUMONIA    A:ND 

less  than  6,090  were  intermittents,  or  38,393  remittents,  and  20  yel 
low  fever ;  the  total  being  44,503  autumnal  or  periodic  cases.1  Dr. 
Kufz,  in  a  communication  made  to  Dr.  Grisolle,2  states,  as  the  result 
of  his  personal  observation,  that  pneumonia  is  very  uncommon  at 
Martinique. 

"Although  we  encounter  in  Senegal,"  says  Thevenot,  "the  greater 
number  of  the  pathological  changes  incident  to  temperate  climates, 
and  although  endemic  diseases  there  differ  in  nothing  but  fre 
quency  and  severity  from  our  own,  yet  the^e  are  some  which  will 
command  almost  exclusively  our  attention,  because  they  prevail 
much  more  frequently  than  all  others.  Eemittent  and  intermittent 
fevers,  dysentery,  hepatitis  and  nervous-  colic  .constitute  the  most 
dangerous  enemies  of  Europeans.  \  At  j$ie  £ame  time  inflammation 
of  the  thoracic  organs,  though  no,t  unknown,  is  rare,  and  in  a  list  of 
952  cases  of  disease,  treated  from  Juljyl$37,  t&  July,  1838,  mala 
rial  fevers  amounted  to  509,  while vpleufigies  and  pjeuro-pneumo- 
nias  did  not  reach  ab<*ve  5."3  At  Bone,  in  Africa,  as  we  learn 
from  Dr.  Maillot,  pneumonia  is  an  excessively  rare  disease ;  while 
malarial  fevers,  on  the  contrary,  abound  to  an  unprecedented  de 
gree.  Of  3,765  cases  of  disease  treated  by  him  from  9th  Febru 
ary,  1834,  to  15th  March,  1835,  only  6  were  affected  with  pleuro- 
pneumonia.4  In  Upper  Canada,  where  malarial  exhalations,  and,  as 
a  consequence,  autumnal  and  periodic  %vers  abound  much  more 
than  in  the  lower  section  of  that  countrj|^neumonia  prevails  much 
less  extensively.  The  proportion  of  the  latter  disease  in  Upper 
Canada,  per  1,000,  is  noted  by  Major  Tullock  at  60;  in  Lower  Ca 
nada  at  30 ;  while  the  proportion  of  intermittent  fevers  per  1,000 
in  the  former  was  178,  and  of  remittent  12;  and  the  proportion  of 
intermittents  in  the  latter  was  only  26  per  1,000,  and  of  remit 
tents  I.5  In  French  Guiana,  and  especially  at  Cayenne,  where 
malarial  fevers  are  proverbially  common,  and  the  climate  is  justly 
considered  in  consequence  as  excessively  insalubrious,  thoracic  in 
flammations  are  rarely  encountered.6  It  is  true  that  Campet  tells 
us  a  very  different  story  on  the  subject.  But  he  admits  that  such 

1  Tullock,  Med.  Statistics  of  Brit.  Army,  46,  47. 

2  Traite  de  la  Pneumonie,  132. 

3  Tr.  des  Maladies  des  Europeans,  dans  les  pays  Ckauds,  232,  240. 

4  Trait<$  des  Fievres  Intermittentes,  114. 

5  Opera,  cit.  27,  B ;  29,  B. 

6  Segond  Apcr9u  sur  le  Climat  et  les  Maladies  de  Cayenne,  1831,  quoted  by  Gri 
solle,  133. 


AUTUMNAL   FEVERS.  65 

inflammations  are  principally  rife  among  the  slaves  who  do  field 
work,  are  destitute  of  proper  clothing,  and  sleep  on  planks  in 
badly  constructed  huts,  where,  unless  protected  by  large  fires,  they 
are  apt  to  suffer  during  the  low  temperature  of  the  night  and  break 
of  day.1  • 

Similar  are  the  results  obtained  on  the  western  coast  of  Africa, 
almost  every  point  of  which  may  be  regarded  as  a  hotbed  of  mala 
rial  fevers.  From  Major  Tullock,  we  learn  that  the  Sierra  Leone 
command  presented,  in  a,  total  number  of  5,489  cases  of  disease, 
2,600  of  fever.  Of  .these,  948  were  of  intermittents,  and  1,601  of 
remittents,  which,  with  51.  of  common  continued,  were  in  the  pro 
portion  of  1,411  per  1,000  of  mean  strength.  In  the  list,  the  affec 
tions  of  the  lungs  figure^  f$r  103,  being  in  the  proportion  of  56  per 
1,000;  and  pneumonia  fcVl5>-,  or  £  per  1,000.2  In  conclusion,  I 
may  here  mention  arfact,  t0-w)hichjGrrisolle  ]aas.  already  called  atten 
tion,  that  Monfalcon,  in  biar'treatise-  on  marsheg,  though  pointing  out 
the  frequency  of  pulmonary  catarrh  in  pali*dal  localities,  nowhere 
enumerates  pneumonia  among  the  diseases  peculiar  to  them  ;3  and 
that  Nepple,  though  asserting  the  fact  in  positive  terms,  disproves  his 
own  statement  by  showing,  that  in  a  total  of  1,352  cases  of  disease, 
admitted  into  the  wards  of  the  Hospital  of  Montluel  (Ain)  during 
the  course  of  four  years,  intermittent  and  remittent  fevers  furnished 
not  less  than  three-seven<th|L  of  the  whole,  while  pneumonia  came  in 
for  only  one-sixteenth.4  ^^the  Ionian  Islands,  with  an  aggregate 
military  strength  of  70,293,  the  cases  of  malarial  fevers  in  twenty 
years,  1817-1836,  amounted  to  16,252,  being  in  the  proportion  of 
230.5  per  1,000,  while  the  cases  of  pneumonia  and  pleurisy  amounted 
to  2,272,  or  31.2  per  1,000.5 

Again,  in  some  parts  of  the  south  of  Spain,  where  acute  inflam 
mation  of  the  lungs  is  rarely  encountered,  paludal  fevers,  on  the 
contrary,  are  very  prevalent,  and  constitute,  with  gastro-enteritic 
and  hepatic  inflammation,  the  great  bulk  of  the  diseases  of  the 
country.6  Dr.  Roux  calls  attention  to  the  fact  of  the  small  propor 
tion  of  thoracic  affections,  acute  and  chronic,  in  the  Morea,  where 
paludal  localities  extend  far  and  wide,  and  where  malarial  fevers 
are  necessarily  abundant.  "  In  France,"  he  remarks,  "  at  this  season 

1  Maladies  des  Pays  Chauds,  210,  2T1. 

2  Mortality  of  the  British  Army,  8-10.  »  Ibid.  500. 

4  Nepple,  Essai  sur  les  F.  Int.  et  Remit.  15,  297.  5  Tullock,  32,  34,  35. 

6  Boudin,  Geog.  Med.  85. 

5 


66  PNEUMONIA    AND 

of  the  year  (January),  if  we  were  to  collect  an  equal  number  of  sick 
in  a  hospital  ward,  we  should  hear  little  else  than  the  sound  of 
cough,  and  many  convalescents  would  present,  at  the  moment  of 
their  discharge,  the  sequelae  of  some  thoracic  affection.  Here,  no 
thing  of  the  kind  occurs."1  Few  countMes  suffer  more  from  mala 
rial  fevers,  intermittents  and  .remittents,  than  the  Island  of  Ceylon.2 
Statistical  returns  of  the  diseases  observed  there  among  Europeans, 
show  that  pneumonia  forms  but  a  small  item  in  the  list,  the  number 
of  cases  being  only  sj^th  of  that  of  all  diseases,  acute  and  chronic.3 
Dr.  Davy  also  states  that  diseases  of  the  lungs  are  exceedingly  un 
common  in  that  island,  both  among  Europeans  and  natives.  Asthma 
and  pneumonia  now  and  then  occur  (p.  491).  According  to  Dr. 
Marshall,  the  proporiign  of  deaths  among  the  troops  from  all  dis 
eases  and  from  pneumonia,  frorjj^  l^JB  tto  1820,  inclusive,  was  as 
follows : —  £ 


From  all  diseases. 

From  pneumonia. 

1816 

.     .     .    v.  .       63  , 

2 

1817 

57 

7 

1818 

513 

6 

1819 

'310 

6 

1820 

139 

8 

This  gives  us  a  total  of  1,082  from  all  diseases,  and  of  29  from 
pneumonia,  or  1  in  37.27. 

During  a  period  of  three  years,  extending  from  21st  of  December 
to  20th  of  the  same  month,  1817-1818, 1818-1819,  and  1819-1820, 
the  number  of  cases  among  European  troops  treated  in  the  hospi 
tals  of  Badula  and  Kandy,  were  as  follows : — 

First  Period.                                    BADULA.  KANDY. 

Fever,  intermittent,    ....  224  746 

"      remittent 163  337 

"      common  continued       .  000  104 

Pneumonia       4  16 

Second  Period. 

Fever,  intermittent    ....  86  170 

"      remittent 94  83 

"      common  continued  .     .  00  84 

Pneumonia       2  00 

1  Hist.  Mod.  de  1'Armee  Francaise  en  Moree,  84. 

2  Davy:   An  Account  of  the  Interior  of  Ceylon,  4to.  493.     Marshall,  Notes  on  the 
Med.  Top.  of  Ceylon,  39.  3  Grisolle,  130. 


AUTUMNAL    FEVERS.  67 


Period.                                      BADULA. 

KANDY. 

Fever,  intermittent    .... 

20 

11 

"      remittent    

13 

3 

"      common  continued  . 

*  00 

108 

Pneumonia 

1 

14 

We  have  here,  in  three  years,  a  total  of  2,246  cases  of  endemic 
fevers  of  various  types ;  while  pneumonia  figures  in  the  list  for  37, 
or  1  in  about  61. 

It  is  to  be  remarked  that  the  few  cases  of  pneumonia  observed, 
occur  principally,  if  not  exclusively,  among  the  Malay,  Indian,  and 
Caffre  tribes;  the  Europeans,  who  are  most  liable  to  endemic  fevers, 
being  comparatively  but  little  liable  to  the  disease.1 

But  these  facts  must  suffice..  So  far  as  thefy  go,  they  seem  con 
clusive  ;  and  with  suitable-de$e&eirfe  to  the  authority  of  writers  who 
entertain  sentiments  different  from  those  which  it  is  my  object  to 
uphold,  I  cannot  think  I  hazard  much  'when  expressing  the  opinion 
that  the  impartial  reader,  after  perusing  what  precedes,  will  acknow 
ledge  that  it  will  puzzle  them,  talented  and  ingenious  as  some  of 
them  undoubtedly  are,  to  reconcile  those  facts  with  the  hypothesis 
set  forth  regarding  the  identity  of  pneumonia  with  malarial  fevers. 
Let  them,  if  possible,  account -for  the  aforesaid  circumstances — the 
absence  of  malarial  fever  where  pneumonia  is  rife ;  and  the  exten 
sive  prevalence  of  the  former  in  localities  where  the  latter  is  either 
not  of  remarkable  frequency,  or  scarcely  seen  at  all — the  cessation 
of  the  one  and  continuance  of  the  other — and  say  how  all  this  could 
be  brought  about,  if  the  inflammation  of  the  lungs,  in  the  disease  in 
question,  were  due  to  the  agency  of  the  cause  producing  those 
fevers ;  in  other  words,  if  pneumonia  were  really  and  substantiallv 
nothing  more  than  a  peculiar  form  of  remittent  and  intermittent 
fever.  "Were  the  etiological  connection  and  pathological  dependence 
such  as  maintained,  we  should  expect  to  find  that  the  cause,  if  dif 
fused  in  such  localities  to  an  extent,  and  possessed  of  a  degree  of 
energy,  sufficient  to  produce  a  large  number  of  cases  of  pneumonia, 
or,  as  others  would  say,  of  the  pneumonic  form  of  autumnal  fever, 
would  also  give  rise  to  a  greater  or  less  number  of  cases  of  the  other 
and  more  legitimate  and  characteristic  forms  of  those  fevers.  This 
would  .be  the  more  natural  to  anticipate,  because  the  climatorial 
influences  noted  in  those  favored  spots  where  fevers  have  never 

1  Notes  on  the  Med.  Topog.  of  the  Interior  of  Ceylon,  92-129. 


68  PNEUMONIA    AND 

prevailed,  or  have  long  ceased  to  do  so,  are  not  different  from  those 
under  the  empire  of  which  such  fevers  everywhere  appear ;  or  have 
remained  the  same  amid  all  the  changes  that  have  occurred  in 
regard  to  their  prevalence; — the  only  difference  consisting  in 
the  absence  or  removal  of  certain  terrestrial  or  local  conditions, 
which,  whatever  be  the  nature  of  their  association  with  the  ordinary 
forms  of  the  supposed  protean  disease,  have  apparently  nothing  in 
the  world  to  do  with  the  existence  of  what  is  now  maintained  to  be 
simply  another  form  of  the  same.  The  result  being  different — 
pneumonia  occurrin^where  autumnal  fever  has  never  originated, 
or  where,  if  it  has  done  so,  it  now  seldom  if  ever  prevails — we  are 
warranted  in  concluding  that  the  ^causes  of  the  two  diseases  are 
different ;  that  the  one  may  exist  without  the  other ;  that  when  the 
two  diseases  show  themselves  at  the*  ( same  time,  and  in  the  same 
locality,  two  sets  of  causes  necessarily  exercise  their  baneful  in 
fluences  and  produce,  not  one  disease  assuming  different  forms,  and 
presenting  different  aspects,  but  two  distinct  complaints;  and  that, 
consequently,  pneumonia  cannot  justly  bef  held  up  as  forming  part 
and  parcel  of  autumnal  fevers,  which,  as  regards  etiology,  are 
governed  by  very  different  laws,  and  influenced  by  very  different 


3.  The  two  diseases  prevail  in  different  seasons. — The  contrast 
between  the  two  diseases  is  particularly  striking  as  regards 
the  seasons  in  which  they  mostly  prevail.  ":As  the  name  usually 
affixed  to  malarial  fevers  indicates,  the  latter  is,  in  our  latitudes 
especially,  a  disease  of  autumn.  It  seldom  appears  before  the 
middle  or  close  of  summer,  and  ceases  on  the  accession  of  win 
ter.  Its  existence  in  an  epidemic  form  in  temperate  regions,  is 
never  known  to  occur  in  the  spring  of  the  year ; — cases  that  occur 
in  that  season,  or  in  winter,  being  accounted  for  without  having 
recourse  to  the  supposition  of  the  development  then  of  the  efficient 
cause.  It  never  shows  itself  in  winter,  and  if  it  appear  early  in 
summer — which  is  seldom  the  case — the  occurrence  is  only  noticed 
under  peculiar  circumstances  of  atmosphere  existing  during  the 
preceding  months,  and  which  invest  these  with  the  characteristic  con 
ditions  appertaining  to  autumn.  It  is  emphatically  a  disease  of  hot 
weather,  requiring  for  its  production  a  continuance  for  some  time 
previous  of  high  atmospheric  heat.  It  appears,  generally,  some  weeks 
after  the  hottest  month;  the  period  being  retarded  as  we  proceed 


AUTUMNAL    FEVERS.  69 

north.  For  the  same  reasons  it  may  readily  be  understood  to  be  a 
disease  of  hot  latitudes,  prevailing,  as  it  does,  violently  and  almost 
perpetually  within  the  tropics,  and  ceasing  long  before  we  reach 
the  polar  circle.  Dr.  Drake,  who  has  npted  all  these  circumstances, 
has,  from  extensive  observations,  arrived  ^at  the  conclusion  that, 
with  the  decrease  of  yearly  and  summer  heat,  other  conditions  re 
maining  unchanged,  there  is  an  abatement  of  fever.  Taking  the 
heat  of  summer  alone  into  consideration,  he  thinks  we  may  assume 
that  a  summer  temperature  of  sixty  degrees  is  necessary  to  the 
production  of  fever ;  that  it  will  not  prevail  ^s  an  epidemic  where 
the  temperature  of  that  season  falls  below  sixty-five  degrees ;  and 
that,  if  the  other  conditions  favouring  its  production  are  deficient, 
it  will  cease  before  those  reductions  of  temperature  have  been 
reached.1 

In  the  Mediterranean  stations,  the  admissions  into  the  hospital, 
and  the  deaths,  average  nearly  twice  as  high  between  July  and 
October  as  during  any  similar  number  of  months  in  the  year.2  In 
Spain  and  Portugal,  the  $i$kly  season,  in  malarial  districts,  is  from 
July  to  September.3  The  fever  of  Kome,  in  general,  is  held  to 
begin  with  the  great  heats  about  the  end  of  June.  The  Roman 
people  have  fixed  on  St.  Peter's  day  as  the  exact  period  of  its  out 
break,  and  it  reigns  from  then  till  it  is  put  a  stop  to  by  the  equi 
noctial  or  autumnal  rains  of  September.  The  readers  of  Horace 
will  recollect  that,  in  Jiis  time,  July  was  notorious  for  its  insalu 
brity.  "  Adducit  febpes  et  testamenta  resignat." 

In  this  country  and  in  Canada  it  commences  in  July  or  August, 
and  ends,  in  the  south  in  November  or  December,  and  in  the  north 
about  October.  In  England,  much  the  same  results  are  obtained.4 

In  hot  latitudes,  where  the  heat  is  almost  constant,  the  fever,  if 
not  constant  also,  commences  earlier  than  in  our  latitudes,  and  lasts 
later  when  not  put  a  stop  to  by  unusual  agencies.  On  the  African 
coast  it  exists  to  some  extent  at  all  seasons ;  but  is  formidable  from 
April  to  November,  and  especially  rife  from  July  to  the  last-men 
tioned  month.  In  Senegal,  thundershowers  commence  towards  the 
close  of  April,  or  beginning  of  May,  and  continue  to  the  middle  of 
July,  when  the  rains  set  in.  This  season  (hivernage)  lasts  to  the  end 

1  A  Systematic  Treatise  on  the  Principal  Diseases  of  the  Interior  Valley  of  North 
America,  712. 

2  Williams,  on  Morbid  Poisons,  ii.  460.         3  Macgregor,  Med.-Chir.  Tr.  vi.  387. 
4  Williams,  op.  ci(.     Watson,  445. 


70  PNEUMONIA    AND 

of  October  or  beginning  of  November.  It  is  at  this  period  (the 
hottest  of  the  year)  that  remittent  fevers  usually  make  their  appear 
ance.1  In  the  West  Indies,  also,  the  period  of  the  greatest  liability 
is  between  July  and  December,  when  the  hottest  weather,  com 
bined  with  considerably  moisture'  prevails.  In  Bengal,  fever  com 
mences  in  August,  and^ntinues  till  November.2  In  Ceylon,  the 
months  of  June,  July,  "an<f  August  are,  in  general,  the  period  of 
the  year  when  the  greatest  sickness  prevails.3  In  a  word,  the 
epoch  of  appearance  and  disappearance  may  vary  in  different 
localities  according  t^  iJie  situation  of  these,  and  their  position 
relative  to  fche  equator,  and  the  consequent  modification  in  the 
period  of  the  <fcsons ;  but  everywhere  endemic  or  autumnal  fevers 
break  out,  or  are  most  rife,  during  or  shortly  after  the  hottest 
weather.  „  "i 

So  far  as  regards  the  yellow  fever$  the  disease  may  still  more 
appropriately  be  denominated  one  of  hot  weather;  requiring,  as  it 
does,  a  higher  average  temperature  during  the  summer  months — 
not  less  than  between  76  and  80  degrees  (Fahr.).  It  manifests  itself 
in  no  climate  where  the  temperature  i&  below  that  average,  and 
ceases  to  appear  long  before  we  reach  the  limits  assigned  to  ordi 
nary  periodic  fevers.  In  our  climate  it  has  commenced  as  early  as 
June.  Such  was  the  case  in  this  city  in  -1799,  and  in  Charleston  in 
1837.  We  even  find  that  in  the  year  1732  '&  appeared  in  the  latter 
city  as  early  as  May.  In  1852,  one  death  by  yellow  fever  was  re 
ported  in  May,  and  another  in  June.  Bi  1819,  the  disease  broke 
out  in  this  city  about  the  end  of  June.  Such,  was  the  case  in  New 
Orleans  in  1848.  But  instances  of  this  kind  are  rare,  and  when 
they  occur,  the  progress  is  at  first  slow,  and  the  disease  presents 
more  the  character  of  a  sporadic  than  of  an  epidemic  visitation. 
More  frequently,  the  fever  breaks  out  about  the  middle  or  end  of 
July,  often  in  August,  and  sometimes  as  late  as  September.  Thus 
it  began  its  epidemic  career  in  the  course  of  July,  in  Philadelphia, 
in  1747,  1794,  1797,  1802,  1803,  1805,  and  1820;  in  Norfolk,  in 
1800,  and  1821 ;  in  Providence  (E.  I.),  in  1805  ;  at  Brooklyn  (N.  Y.), 
in  1809  ;  in  New  York,  in  1799,  and  1803 ;  at  Woodville  (Miss.),  in 
1845 ;  in  New  Orleans,  in  1817,  1844,  1847,  and  1853 ;  Eodney,  in 
1847 ;  Boston,  1798,  and  1819.  Our  epidemics  of  1699,  1762,  1793, 

1  Levacher,  48.  2  ciark  on  Long  Voyages,  i.  110. 

3  Marshall,  Topography  and  Diseases  of  Ceylon,  89. 


AUTUMNAL    FEVERS.  71 

1798,  commenced  in  August,  as  did  also  those  of  Charleston,  in  1732, 
1739,  1745,  1748,  1849,  1852;  of  Baltimore,  in  1798;  of  New 
York,  in  1791,  1797;  of  Providence,  in  1798,  and  1800;  of  New 
London,  in  1798 ;  of  Boston,  in  1819 ;  of  Wilmington  (Del.),  in 
1798,  and  1800 ;  of  Natchez,  in  1817, 1819,  \823,  and  1825  ;  of  New 
Orleans,  in  1819  ;  of  St.  Augustine,  in  1839  ^of  Mobile,  in  1819, 1843,, 
and  1847 ;  and  of  Yicksburg,  in  1847.  In  Gibraltar,  Leghorn,  and 
the  various  cities  of  Spain  where  £he  fever  has  prevailed — as  Medina, 
Sidonia,  Malaga,  Antiquar,  Cadiz,  Barcelona,  Xeres,  &c.,  the  period 
of  appearance  has  varied  from  July  to  Seplfermber ;  never  earlier  nor 
later.  But  in  Europe,  as  in  this  country,  at  whatever  |ime  the  dis 
ease  may  break  out,  it  ceases  as  an  epidemic,  or  cv^|  altogether  in 
October,  November,  or  December. 

In  the  West  Indies,  and  on  the  African  coast,  it  makes  its  ap 
pearance,  as  might  easily  ha^e  been  foreseen  from  the  greater  pre 
cocity  of  the  4iot  season,  at  an  earlier  period  than  it  usually  does 
in  this  country  and  in  Europe  i  while  in  some  years,  owing  to  the 
greater  encroachment  of  hot  weather  on  the  autumnal  months,  it 
breaks  out  later  than  it  $oes  in  temperate  latitudes — the  period 
varying  from  April  (or  even  earlier,  as  was-  the  case  at  Granada,  in 
1793,  when  it  showed  itself  in  February)  to  the  middle  or  close  of 
September. 

If  we  now  turn  to  pneumonia,  we  shall  find  that  the  period  of  its 
prevalence  is  very  different  from  that  of  the  disease  just  referred  to. 
Hippocrates,  some  three  t&ousand  years  ago,  and  Areteus  after  him, 
pointed  out  the  winter  as  the  season  in  which  the  disease  manifests 
itself  most  commonly,  and  subsequent  writers  have  generally  united 
in  that  sentiment.  Sydenham,  it  is  true,  and  after  him  the  learned 
commentator  of  Boerhaave,  affirmed,  as  the  result  of  their  observa 
tions,  that  the  disease  attains  its  maximum  between  spring  and 
summer.  But  the  statement  has  not  always  been  confirmed  by 
subsequent  authorities  in  this  country  and  Europe.  According  to 
Chomel,  pneumonia  is  more  particularly  rife  in  winter,  spring,  and 
the  commencement  of  summer,  and  is  rarely  seen  at  the  close  of 
the  latter  season  and  during  the  autumn.  Of  97  cases  observed  by 
that  writer  and  Louis,  at  the  Charity  Hospital  of  Paris,  81  occurred 
between  February  and  August,  and  16  only  daring  the  other 
months.1  Of  357  cases  recorded  by  Leroux,  and  cited  by  Grisolle, 

J  Diet,  de  Med.  xvii.  210,  1st  ed. 


72  PNEUMONIA    AND 

116  occurred  in  winter,  137  in  -spring,  58  in  summer,  and  44  in 
autumn.  Andral  states  that  the  disease  prevails  mainly  in  the  spring 
months — March,  April,  and  May.1  The  following  are  the  results 
obtained  by  Grisolle  in  an  examination  of  296  cases: — 


January 20 

February      ....  40 

March      ....'.  47 

April 62 

May 40 

June    .  8 


July 13 

August 3 

September    ....  5 

October 2 

November    .     .     .     .  22 

December  34 


Admitting  this  to  be  a  fair  representation  of  the  comparative 
monthly  freqi^n<a|f  of  the  disease , among  adults  in  Paris,  it  follows 
that  pneumonia  attains  its  maximum  in  April.  Next  come  in  order 
of  frequency,  March,  February,  and  May ;  then  December,  Novem 
ber,  and  January ;  while  August  and  October  present  the  smallest 
number  of  cases.2  Hourman  and,  J)echambre,  cited  by  Grisolle,  who 
investigated  the  subject  among -the  aged  inmates  of  the  Salpetriere, 
found  the  cases  more  numerous  in  March.3  At  Geneva,  on  the  con 
trary,  the  disease  often  attains  its  maximum  ill  May  ;4  while  among 
children,  Eilliet  and  Barthez  point  out  February  as  the  month  of 
greatest  frequency — a  result  modifie^,  doubtless,  as  Grisolle  re 
marks,  by  the  circumstance  that  the  »fluenza  was  then  existing  in 
Paris.  Facts  very  similar  to  those  suited  are  recorded  as  being 
usually  observed  in  England,  in  the  more  northern  and  southern 
districts  of  Europe,  at  Malta,  in  Bermuda,  Nova  Scotia,  Canada, 
and  in  every  part  of  this  country  and  South  America.5  Every 
where,  among  adults,  children,  and  old  people,  idiopathic  or  primi 
tive  pneumonia  appears  to  attain  the  maximum  of  frequency  at 
the  close  of  winter  and  in  the  spring,  especially  during  the  months 
of  March  and  April.  Next  in  point  of  frequency  is  the  winter; 
while  the  disease,  though  not  unknown  in  summer,  is  comparatively 

1  Mcd.  Clinique,  i.  513.  2  Grisolle,  137. 

3  Op.  cit.  and  Archives,  xii.  2d  series.  30. 

4  Essai  Statistique  sur  la  Mortalite  du  Canton  de  Geneve,  Ann.  d'llyg.  xxiii.  51. 

5  Williams,  Cycl.  of  Pract.  Med.  iii.  407;  J.  Frank,  311;  Andral,  i.  513;  Tullock, 
44,  B  ;  Wilson  Philip,  Tr.  on  Symptom.  Fever,  204  ;  Briquet,  Arch.  Gen.  vii.  3d  s.  482  ; 
Ramsay,   Charleston  Journ.   vi.    1,  2;    Bell    and  Stokes,   ii.   207;    Smith    on  Epid. 
80;  Johnson  and  Harris,  Trans.  Am.   Med.   Assoc.   v.  373;   Gerhard,  Amcr.  Journ. 
1834;  Ed.  F.  Williams,  Stethoscope,  ii.  544;  Lafargue,  Bulletin  de  1'Acad.  xvii.  198 


AUTUMNAL   FEVERS.  73 

of  rare  occurrence  during  that  season,  and  perhaps  still  more  so 
during  the  autumnal  months. 

Grisolle  mentions  farther,  that  .of  thirteen  epidemics  of  pneu 
monia,  the  authenticity  of  which  cannot  be  contested,  seven  com 
menced  in  spring,  four  in  winter,  one  in  autumn,  and  one  in 
summer.1  The  epidemics  noticed  in  this  country  have  usually 
commenced  in  winter,  and  prevailed  in  thaj  season  and  spring,  the 
latter  often  furnishing  the  greatest  number  of  the  cases. 

4.  They  appear  under  the  influence  of  opposite  winds. — It  is  not  to 
be  forgotten  that  the  two  diseases  do  not  usually  manifest  them 
selves  under  the  influence  of  the  same  order  of  winds.  So  far  as 
regards  malarial  fevers,  not  a  little  in  this  mat^r  mill  depend  on 
the  nature  of  the  surface  over  which  the  wind  may  happen  to  pass 
before  reaching  the  locality  where  the  disease  prevails;  for  at  the 
proper  period  of  the  year,  other  things  being  favourable,  fever 
will  appear,  as  we  shall  see,  in  connection  with  any  currents  which 
waft  the  air  from  neighbouring  surfaces  where  the  elaboration  of 
the  morbific  cause  is  going  on.  Edinburgh  is  supposed  to  derive 
fever  through  the  agency  of  the  east  wind,  which  blows  it  from 
Holland.  The  same  wind  wafts  malaria  from  Essex  to  London. 
The  north-east  wind  blows  ^malarial  fever  into  some  portions  of 
Home.  Generally  speakingjaftie  western  coast  of  Italy  contains  a 
more  extensive  elaborating  'Surface  than  the  eastern,  in  consequence 
of  which,  other  circumstances  being  equal,  the  western  currents  are 
more  prolific  of  fever  than  their  antagonists.  The  same  thing,  and 
for  the  same  reason,  occurs  in  Europe  generally,  from  the  fron 
tiers  of  Asia  to  the  other  extremity  of  that  continent.  In  Batavia, 
the  north-east  wind,  which  is  very  prevalent  during  July,  August, 
and  September,  is  highly  unfavourable  to  health.2  So  are  the  north 
winds  at  New  Orleans  during  summer,3  and  the  east  and  west  winds, 
at  the  Havana.4  In  Normandy,  at  Berniere,  an  unusual  course 
of  south-west  winds  blowing  across  a  pestiferous  region,  and  con 
spiring  with  a  hot  summer,  caused  several  violent  epidemics.5  In 
London,  the  south-east  winds  are  apparently  unfavourable  for  the 
same  reason.6  The  same  thing  occurs  in  Dutch  Guiana. 

1   Op.  cit.  139.  2  HorsefielJ,  Med.  Mus.  i.  79. 

3  Report  on  Fever  of  1819,  p.  50;  Chabert,  viii.  pp.  9,  26. 

4  Osgood,  29.  5  Macculloch  on  Malaria,  351. 
6  Second  Report  of  Loud.  Commissioners,  40. 


74  PNEUMONIA    AND 

"  Yellow  fever,"  says  Dr.  Bone,  "  prevails  on  Brimstone  Hill,  St. 
Kitts,  when  the  strong  north  winds  that  have  swept  foul  ground  on 
Mount  Misere  impinge  upon  the  persons  in  the  ill-constructed  bar 
racks  and  out-buildings  on  that  hill.  And  in  Tobago,  Dominica, 
Grenada,  St.  Vincents,  and  in  all  the  hilly  uncleared  islands  of  the 
West  Indies,  strong  north  and  east  winds  and  rain,  impinging  upon 
the  troops  and  their  families  in  ill-constructed  barracks,  are  causes 
of  the  disease."1  "In  St.  Domingo,"  says  Desportes,  "the  acclimated 
inhabitants  regard  the  north  wind  as  unwholesome,  while  the  south 
wind  is  very  j>etaiicious  to  new-comers.  This  is  particularly  noted 
in  the  plain  of  the  Cape,  because  the  nort^-east  and  north-north-east 
winds,  before  reaching  it,  pass  over  a  large  surface  of  marshy  locali 
ties,  from  the  effdct  of  the  exhalations  of  which  the  natives,  who  are 
proof  against  seasoning  fevers,  are  no.t  exempt."2 

In  this  city  and  country,  instances  of  the  kind  might  be  cited  in 
abundance ;  but  they,  as  well  fes  many  others,  will  find  a  more 
appropriate  place  in  another  part  of  the  pre|^at  volume. 

But  however  true  it  may  be»  that  particular  currents  of  winds 
exercise  a  baneful  influence  in  the  way  mentioned,  it  is  not  less  a 
fact  which  experience  will  everywhere  confirm,  that  the  existence 
of  malarial  fevers  has  almost  invariably  been  connected,  in  tem 
perate  regions  particularly,  with  the  prevalence,  during  a  greater  or 
shorter  space  of  time,  of  southerly  currents,  and  that  the  influence 
that  these  exercise  is  not  necessarily,  and  in  some  forms  of  the 
disease  is  very  seldom,  dependent  on  the  malarial  nature  of  the 
localities  over  which  they  happen  to  pass.  Nor  could  this  well  be 
otherwise ;  for  these  fevers  require  for  their  development  the  long 
continuance  of  a  range  of  thermometrical  heat,  which  could  seldom 
be  obtained  during  the  prevalence  of  opposite  currents.  Under  the 
influence  of  these  winds,  whether  from  due  south,  or  from  the 
neighboring  points,  S.  E.,  E.  S.  E.,  or  S.  W.,  accompanied,  as  they 
are,  with  heat,  and  in  many,  if  not  most  malarious  regions,  with  hu 
midity,  fever  originates  and  spreads  to  a  greater  or  less  extent; 
while  from  a  change  of  these  to  other  winds  blowing  from  the 
opposite  points  of  the  compass,  as  N.,  N.  W.,  or  N.  E.,  there  results 
a  beneficial  change  in  the  healthfulness  of  the  infected  locality  ;— 
a  diminished  prevalence,  or  even  a  cessation  of  the  fever.  In 
tropical  climates,  where  the  most  frequent  variations  are  from 

1  Essay,  15.  2  Maladies  dc  St.  Dominguc,  vol.  i.  i!l. 


AUTUMNAL    FEVERS.  75 

E.  S.  E.  to  E.  N.  E.,  and  where  the  wind  never  remains  long  at  N. 
E.  or  S.  E.,  and  rarely  blows  from  due  north  or  due  south,  the  pre 
vailing  current  is  always  attended  with  considerable  heat  and  moist 
ure  ;  and  with  few  exceptions,  when  the  wind  blows  from  the  west 
longer  than  usual,  and  when  the  heat  is  nevertheless  very  great, 
as  at  Martinique  <  in  1839, l  the  prevalence  of**fever  is  very  usually 
associated  with  south-east  or  easterly  currents.2  One  of  the  writers 
to  whom  I  have  referred  •  below,  and  whose  ample  experience  and 
great  accuracy  of  observation  cannot  be  doubted,  remarks  on  the 
subject :  "The  development  of  the  yellow  fever  in  th%  West  Indies, 
in  a  great  number  of  me&  at .  the  same  time,  in  different  parts,  at 
a  distance  from  each  other,  on  a  level  with  the  sea,  or  slightly  above, 
on  board  vessels  in  port  or  at  sea,  coincides  so  exactly  with  the  in 
crease  of  heat  and  humidity,  and'  with  the  prevalence  of  the  south 
winds,  that  it  is  impossible  not  to  recognize  in  these  meteorological 
conditions  the  true  cause  of  the  epidemics  of  yellow  fever.  The 
effect  here  is  intimati$^  and  necessarily  connected  with  its  cause. 
The  production  and  extension  of-  yellow  fever  under  the  prolonged 
influence  of  the  south  winds,  is  a  fact  observed  by  every  one ;  so  in 
evitable,  indeed,  that  it  can  be* predict&d  without  fear  of  ever  being 
mistaken.  This  action  of  the  south  winds  is  felt  here  by  everything 
that  breathes.  They  produce  undefmable  effects  on  our  senses. 
We  feel  them  in  bed,  or  sifting  at  the  desk ;  they  enervate,  cause 
oppression,  and  depress  the  spirits.  To  say  in  what  these  atmo 
spherical  alterations,  the  effects  of  which  are  so  much  to  be  dreaded, 
consist,  and  to  seek  to  determine  their  specific  nature,  is  doubtless 
a  task  beyond  the  faculty  of  man."  "It  is  a  fact,  I  cannot  say  it  too 
often,  that  yellow  fever  is  never  developed  in  the  same  manner  as 
other  epidemics,  but  by  and  under  the  influence  of  the  south  winds. 
When  this  general  cause  fails,  the  yellow  fever  only  exists  in  cer 
tain  restricted  places,  or  only  a  few  sporadic  cases  appear  here  and 
there,  as  occurred  in  1819  and  1820.  There  were  only,  in  all,  forty- 
two  men  attacked  by  the  yellow  fever  in  the  Hospital  of  Fort 
Royal  in  1820,  and  yet,  notwithstanding,  the  garrison,  including  sol- 

1  Rufz,  29,  54. 

2  Desportes,  19;  Lcmpriere,  i.   IT;  Bally,  361;   Gilbert,   12;  Humboldt,  765;  Ro- 
choux,  113;    Lefort,  Du  Quinquina  et  de  la  Saignee,  £c.  p.  66;  Ib.  Mem.  sur  la  non 
Cont.  de  la  F.  J.  9;  Leblond,   81;  Lind  on  Seamen,    67;  Dariste,    33;  Arnold,   26; 
Savaresi,  189,  242-3;  Moreau  de  St.  Mery,  716;  Chiskolm,  88;  Chervion  Kept,  on 
Rufz,  45 ;  Catel,  20 ;   Olivet,  6  ;  Vincent,  7. 


76  PNEUMONIA    AND 

diers,  seamen,  and  military  workmen,  was  very  numerous ;  but  in 
that  year  the  wind  did  not  blow  from  the  south,  or  only  occasion 
ally,  and  never  more  than  twenty -four  hours  at  a  time.  It  may, 
moreover,  be  remarked  that  this  injurious  influence  of  the  south 
wind,  or  of  winds  from  neighbouring  points  of  the  compass,  is  ob 
served  under  the  same  parallels  Q£  latitude  or  in  corresponding 
parts  of  our  hemisphere." 

In  temperate  regions,  the  concurrence  of  southerly  winds  would 
seem  to  be  even  more  requisite  than  it  is  i&:  the  West  Indies,  be 
cause,  in  these^the  long  continuance  of  the  degree  of  heat  necessary 
for  the  elaboration  of  the  malarial  poison  may  and  does  exist,  as  is 
seen  during  sem«  sickly  season,  without  the  aid  of  such  currents ; 
whereas,  in  the  former  region,  the  tempe$$£ire  seldom  if  ever  attains 
the  degree  alluded  to,  or  remains  at*  re  long,  except  under  the  in 
fluence  of  the  south  wind  or  it$ collaterals.  Indeed,  it  is  doubtful 
whether,  in  our  latitudes,  fever%  of  a  malignant  character,  particu 
larly,  have  often  been  found  to  prevail  under  *>  very  different  con 
dition  of  aerial  currents.  It  was  under  the  influence  of  the  warm 
winds  that  the  fever  described  by  Hippocrates,  and  which  is  so 
closely  allied  to  the  worst  forms  of  the  malarial  fevers  of  Algeria 
and  our  Southern  States,  appeared.  Tt|je  yellow  fever  of  Anda 
lusia,  Cadiz,  Carthagena,  and  other  cities  of  Spain,  has  almost  in 
variably  shown  itself  during  the  prevalence,  or  after  a  prolonged 
continuance,  of  the  Levanter,  or  east  wind,  which  is  both  hot  and 
damp.  Such  has  also  been  generally  the  case  at  Gibraltar.1  In 
Italy,  the  south  and  south-west  winds  are  the  usual  attendants  on 
fever  periods.2  In  Sicily,  matters  are  not  very  different.3  In  like 
manner,  in  this  city,  and  other  parts  of  the  United  States,  the  yel 
low  and  other  forms  or  varieties  of  malarial  fevers,  usually,  if  not 
always,  break  out  and  prevail  during  the  continuance  of  south  or 
some  other  hot  winds.4  In  a  word,  the  production  and  continuance 

1  Tullock's  Report,  4;  London  Quarterly  Rev.  Ixvi.  135,  6;  Vance's  Rep.  in  Pym, 
60;  Fellows  on  Pestilential  Fever,  13,  15,  469;   Berthe  Fievre  J.  51 ;  Parisct,  F.  J.  de 
Cadiz,  96  ;  Gilkrest,  Cycl.  of  Practical  Med.  ii.  279  ;  O'Halloran  on  Yel.  Fev.  of  Spain, 
14;    Wilson,    Fev.   of  Gibraltar,  Chervin's    Translation,  9;    Rochoux,   113;    Gilpin, 
Med.-Chir.  Trans,  v.  339;   Bally,  363;   Amiel,  in  Johnson  on  Trop.  Cl.  260;   Town- 
send's  Spain,  340 ;   Maclean  on  Epidemics,  ii.  485. 

2  Carricre,  Climat  de  1'Italie,  462 ;  Valentin,  Voy.  Mdd.  45 ;  Baglivi,  Opera  Omnia, 
157-8;  Edinburgh  Rev.  xxxvi.  542.  3  Boyle,  Edinb.  J.  viii.  178. 

4  Caldwell  on  Malaria,  135 ;  Ib.  Med.  Repos.  vii.  144-5  ;  Barnwell,  366 ;  S.  Jackson, 
40;  Waring,  23;  N.  0.  Kept,  for  1839,  156;  La  Revue  Mod.  for  1840,  322;  Rand. 


AUTUMNAL   FEVERS.  77 

of  autumnal  fevers — periodic  and  yellow,  is  usually  connected  with 
the  prevalence  of  southerly  winds ;  and  on  inquiry  it  will  be  found 
that  in  instances  when  a  different  result  was  obtained,  the  thermo 
meter  had  nevertheless  ranged  high.-  •  r 

Now,  how  do  matters  stand  in  that  respect  as  regards  pneumo 
nia  ?  If,  in  some  localities,  as  at  Gibraltar,  for  example,  the  disease 
prevails  most  usually  during  those  periods  of  the  "year  when  west 
erly  winds  are  predominant ;  if  the  disease  also  is  found  to  occur 
more  frequently  in  ol&er  places  under  the  influence  of  different 
currents,  it  may  be  laid  down  as  a  genetal  rule,  tha^  north,  north 
east,  and  north-west  winds  are  those  during  the  prevalence  of 
which  thoracic  inflammations  are  more  frequently  .developed.  Such 
was  found  to  be  the  casfcjjj£i  the  north  of  Italy  and  Germany  by 
J.  Frank.1  Le  Pecque  de  la"  'Gloture2  made  similar  observations  in 
Normandy,  as  did  also  Hourmann  l&nd  Deckambre,3  and  Grisolle,4 
at  Paris.  Of  fifty-four  cases  of  th#  disease  observed  by  the  latter 
author,  fifteen  occurred  with  a  north-east  wind ;  eleven  with  north 
west  ;  three  with  north  wind ; '  five  with  south-east ;  eight  with 
south-west,  and  eight  during  -a  perfect  calm.  Hippocrates,  long  ago, 
noted  the  prevalence  of  pneumonia  under  the  influence  of  north 
and  north-east  currents  in  Greece.  "  But  the  following  is  the  con 
dition  of  cities  which  have  the  opposite  exposure,  namely,  to  cold 
winds,  between  the  summer  settings  and  the  summer  risings  of  the 
sun,  and  to  which  those  winds  are  peculiar,  and  which  are  sheltered 
from  the  south  and  the  hot  breezes."  "  The  diseases  which  prevail 
epidemically  with  them  are  pleurisies,  and  those  which  are  called 
acute  diseases."5  Similar  results  have  been  noted  in  England,6  in 
Nova  Scotia,  and  Bermuda ;  and  it  can  scarcely  be  necessary  to  add 
that  in  this  country  pneumonia  is  almost  invariably  associated  with 
the  prevalence  of  northerly  currents — N.,  N.  E.,  N.  W.,  or  west. 

5.  Pneumonia  is  of  yearly  occurrence — not  always   so  fevers. — In 
connection  with  this  subject,  it  may  be  mentioned  that  in  places  lia- 

Med.  Repos.  ii.  466;  Valentin,  85-6,  89;  Fev.  of  Baltimore  in  1819,  95;  Archer, 
Recorder,  v.  61 ;  Bailey,  55  ;  Townsend,  55  ;  Merrill,  Phil.  J.  ix.  233 ;  Barton,  Fev. 
of  N.  0.  in  1833,  p.  9. 

1  Op.  tit.  312.  2  Malad.  Epid.  1st  pt.  15. 

3  Arch.  Gen.  2d  s.  xii.  30.  4  Op.  tit.  141. 

5  Airs,  Waters,  and  Places;  Syd.  Soc.  Ed.  i.  193;  Littrg's  Tr.  ii.  19-21. 

6  Cyclop,  of  Pract.  Mod.  iii.  407. 


78  PNEUMONIA    AND 

ble  to  pneumonia,  the  appearance  of  the  disease  is  of  yearly  occur 
rence.  The  cases  may  fluctuate  in  respect  to  their  number.  There 
may  be  comparatively  few  o#e  year  and  many  on  another  occasion. 
At  other  times,  the  disease  may  assume  the  character  of  an  epidemic. 
But  nowhere  and  on  no  occasion  has  -it  been  known  to  disappear 
during  the  whole  of  ttye  season  at&^hich  it  usually  prevails,  or 
during  an  entire  year ;  still  less  ha$  it  been  known  to  fail  entirely 
during  a  series  of  ^ears,  and  to  recommence  its  course  as  here 
tofore  after  a  long  period  of  repo^S.  Nor  does  it  suddenly  visit 
localities  to  which  it  had  Before  been  a  stranger;  and,  after  scourg 
ing  them  for  one  or  more  seasons,  disappear  and  be  seen  no  more. 
The  disease,  beiiisg  the  offspring  of  <jau$es  which,  as  we  shall  see  by 
and  by,  are  strictly  local  in  their  .chsracler  and  dependent  on  parti 
cular  states  of  tht  sensible  qualities  of  tjB«itmosphxere,  which  do 
not  differ  very  materially  in  the  same  localities  in  successive  years, 
must,  and  does  consequently,  show  itself  more  or  less  extensively 
at  each  return  of  its  appropriate  season  witj^ouf  being  much,  if  at  all, 
influenced  in  the  frequency  of  its 'manifestation,  far  less  prevented 
entirely,  by  modificatjja^  in  the  condition  of  the  soil  or  of  surround 
ing  objects. 

But  while  such  is  the  case  in  relation  to  pneumonia,  a  different 
result  obtains  in  regard  to  autumnal  or 'periodic  fevers  of  various 
grades  and  types.  Every  one  knows  in  |^is  country  that  although 
the  bilious  remittent  fever,  the  endemic  of  many  localities  from  one 
extremity  to  the  other  of  our  vast  republic,  appears  in  such  places 
to  a  greater  or  less  extent,  every  year  at  stated  periods,  seasons 
occur  at  which  it  does  so  in  so  trifling  a  degree  as  to  attract  little 
notice ;  and  others  again  when  it  does  not  show  itself  at  all.  On 
the  other  hand,  it  is  a  fact,  placed  beyond  the  reach  of  doubt,  that 
the  disease  is  sometimes  observed  to  spread  extensively  over  a  large 
expanse  of  country,  attacking  places  that  had  been  for  several  or 
many  years  almost  or  completely  exempt  from  its  ravages.  Such 
was  the  case  in  1822,  and  a  few  succeeding  years,  when  the  disease 
swept  over  immense  tracts  of  country,  in  many  portions  of  which  it 
had  not  been  heard  of  for  many  years  before.  Similar  observations 
have  been  made  in  different  parts  of  Europe,  England,  France,  Spain, 
Italy.  In  the  West  Indies,  many  facts  might  be  adduced  in  proof. 
Chisholm,  in  the  18th  volume  of  Duncan's  Medical  Commentaries, 
describes  an  epidemic  of  remittent  fever  which  occurred  in  the 
vicinity  of  St.  George,  Grenada,  in  1792 ;  on  which  occasion  the 


AUTUMNAL   FEVERS.  79 

disease  spread  in  an  unprecedented  manner,  and  attacked  spots 
heretofore  viewed  as  salubrious.  The  following  remarks  by  Dr. 
Imray,  in  relation  to  the  endemic  of  f)ominica,  will  apply  equally 
to  the  fevers  of  other  islands :  "  The  causes  of  our  endemic  fevers 
reside  permanently  in  some4ocalities ;  but  in  certain  seasons,  remit 
tent  and  intermittent  fevers  "t*eot>me  prevalent  throughout  the  island." 
"  Though  the  causes  from  whidb  periodic  fevers  originate  are  per 
manent  in  the  country,  yet  do  they  not  always  operate  with  the 
same  energy.  Sometimes  thes^  morbific  agencies  remain  in  almost 
a  quiescent  state,  andnfevers  occur  comparatively  rarely.  At  other 
times,  they  manifest  unusual  activity,  and  then  we  have  remittent 
and  intermittent  fever  in  abundance."1  ty 

Still  more  striking  are  trfe  intervals  observed  between  the  epi 
demic  manifestations  ojfSjJellow  fever,  the  elaboration  of  the  cause 
of  which  is  of  much  less  frequent  occurrence  than  that  of  ordinary 
autumnal  pyrexia.  When  the  disease  broke  out  at  Charleston  in 
1792,  it  had  not  preVaile^l  there  .during  the  long  period  of  37  years. 
It  did  not  reign  in  that  city  from  1807  to  1817,  from  1830  to 
1838,  or  from  1839  to  1849,  and  has  seldom  at  any  epoch,  from 
1690  to  this  day,  prevailed  in  two  successive  years.2  In  New 
York,  it  has  shown  itself  often  at  long  intervals;  the  years  of 
epidemic  there  having  been  1741,  1743,  1751,  1762,  1791,  1795, 
1796,  1798,  1804,  1805,  £§19, 1822.  In  this  city,  it  did  not  prevail 
from  1699  to  1742.  It  next  showed  itself  in  1747,  1749,  1762. 
From  the  latter  year  to  1793,  a  period  of  81  years,  there  was  a  com 
plete  repose.  The  disease  again  showed  itself  in  1794,  1797,  1798, 
1799,  1802,  1803,  and  1805,  and  lastly  in  1820.  From  the  last- 
mentioned  year  to  the  present,  1853 — when  the  fever  again  made  its 
appearance,  in  a  mild  epidemic  form,  the  number  of  cases  not  hav 
ing  reached  above  170 — the  city  remained  free  from  it.  During 
some  of  these  intervals,  sporadic  cases  occasionally,  but  very  rarely, 
presented  themselves.  Kindred  occurrences  have  been  observed  in 
Boston,  New  Orleans,  Mobile,  Baltimore,  and  others  of  our  cities ; 
in  some  of  which,  indeed,  the  disease  has  occurred  on  a  few  occa 
sions  only.  "When  it  broke  out  at  Cadiz,  in  1800,  it  had  not  been 
seen  there  for  36  years ;  the  last  visitation  being  that  mentioned  by 
Lind  as  having  occurred  in  1764.  Barcelona,  which  suffered  so 

1  Observations  on  the  Character  of  Endemic  Fever  in  the  Island  of  Dominica,  Edin. 
Journ.  Ixx.  284. 

2  Simons,  Charleston  Journ.  vi.  779.         , 


80  PNEUMONIA    AND 

severely  in  1821,  had  not  been  visited  by  it  since  1803.  It  had  not 
been  seen  at  Gibraltar  for  a  century,  at  the  time  of  its  outbreak  in 
1804.  At  Vera  Cruz,  the  city  was  free  from  1776  to  1794.  If 
we  except  Sir  W.  Pym,  and  a  few  others  of  the  same  school,  physi 
cians  who  are  conversant  with  the  yellow  fever  of  the  West  Indies, 
whether  they  be  continent  or  absolute  contagionists  or  anti-con- 
tagionists,  have,  from  the  days  of  Towne  and  Desportes  to  our  own, 
admitted  and  continue  to  admit  that  the  disease,  such  as  it  exists 
there,  is  a  native  of  the  soil,  and  prevails  more  frequently  than 
anywhere  else.  And  yet  there  is  not  "one  among  them  who  does  not 
know  that  the  fever  is  not  of  annual  occurrence  in  those  islands. 
Sporadic  cases  dl^btless  occur  frequently  during  some  seasons.  At 
others,  howeve^j  they  are  seldom  seen ;  and  at  some  again,  they 
are  almost,  if  not  altogether,  unknown.  JLf  we  open  Desportes's 
excellent  work  on  the  Diseases  qf  St.  Domingo,  we  shall  find  that  in 
the  course  of  the  fourteen  years  he  resided  at  the  Cape,  the  place 
was  free  from  the  fever  duripg  five.1  At  Martinique,  yellow 
fever  did  not  appear  from  1827  to  1838.  Grenada,  when  visited 
in  1793  by  the  epidemic  described  by  Chisholm,  had  not  suffered 
for  31  years.  Dominica  was  also  exempt  from  1817-1821  to  1838. 
Georgetown,  Demerara,  suffered  severely  in  1793 ;  next,  in  1803 ; 
then  in  1819.  From  that  year  to  1837  the  disease  did  not  show 
itself  in  the  epidemic,  if  indeed  in  any  form.2 

"We  find  malarial  fevers  starting  up  even  in  times  not  character 
ized  by  the  existence  of  an  epidemic  constitution ;  sometimes  from  a 
slight  change  in  the  local  condition  of  the  soil  or  of  surrounding 
and  sheltering  objects,  in  spots  where  it  had  not  been  seen  before. 
Fever  has  for  years  gradually  impinged  on  the  city  of  Kome.  It  is 
to  this  day  spreading,  and  every  year  reaches  some  parts  of  the  city 
where  it  was  before  unknown. 

On  the  other  hand,  from  the  operation  of  causes  which  it  is  not 
necessary  to  enumerate,  fever,  as  we  have  already  seen,  diminishes 
or  even  disappears  from  localities  where  it  had  before  prevailed 
more  or  less  extensively. 

6.  Their  altitudinal  range  is  not  the  same. — Every  one  acquainted 
with  the  habitat  of  autumnal  or  periodic  fever  must  be  aware  that 

1  Chervin,  De  I'identite"  des  Fievres  d'origine  Paludeenne  de  differens  type,  5-83. 

2  Frost,  Med.  Repos.  12  and  13;    Blair,  Some  Account  of  the  Last  Yellow  Fever 
Epidemic  of  British  Guiana,  28. 


AUTUMNAL    FEVERS.  81 

its  cause  is  not  exhaled,  or,  if  so,  is  inoperative  beyond  a  certain 
degree  of  elevation  above  the  level  of  the  sea ;  an  effect  due,  like 
that  resulting  from  Northern  latitudes,  to  the  absence  of  the  aver 
age  of  temperature  required  for  the  elaboration  of  the  cause  in 
question,  or  for  rendering  the  system^redisposed  to  its  impress. 
But  whatever  be  the  elevation  afc  which  i%  shows  itself,  its  usual 
places  of  abode  are  valleys,  plain  surfaces,  the  banks  of  streams, 
lakes,  and  the  like ;  while  it  very  commonly  spares  high  and 
well- aired  situations.  If  it  attack  these — which  J£  occasionally 
the  case — the  effect  is  often  clue  to  the  cnuse  being  wafted  thither 
by  the  wind,  and  sometimes,  though  more  rarely,  to  the  existence 
in  the  vicinity  of  sources'ibf  morbific  exhalations,  (fliof  a  soil  which 
from  its  natural  constitution  is  calculated,  independently  of  true 
marshy  conditions,  to  give  rise  to  such  exhalations.  As  regards 
the  yellow  fever,  the  altitudinal  range,  of  which  is  below  that  of 
ordinary  autumnal  or  periodic  fevers,  it.  has.iiever  been  known  to 
appear  on  high,  and  rarely  on  hilly  .situations.  Indeed,  it  has  sel 
dom,  if  ever,  shown  itself  in  any  other  than  localities  of  a  very 
opposite  character.  On  this  subject,  however,  I  shall  have  occasion 
to  dwell  in  detail  in  the  next  chapter,  and  need  not  say  more  about 
it  at  present. 

If,  with  these  facts  before  us,  we  inquire  how  matters  stand  in 
relation  to  pneumonia,  we  shall  find  that,  on  this  point,  as  on  the 
several  others  already  examined,  the  disease  differs  widely  from 
autumnal  and  periodic  fevers.  For,  while  the  latter  cease  to  appear 
in  localities  situated  at  a  certain  degree  of  elevation  above  the  level 
of  the  sea,  in  the  same  way  as  they  do  at  certain  degrees  of  latitude, 
no  elevation  of  the  kind  has  as  yet  been  pointed  out  as  forming  a 
barrier  to  the  production  of  pneumonic  inflammation.  Let  fever 
stop  as  an  epidemic,  or  endemic,  or  as  a  sporadic  disease,  where  it 
may,  the  inhabitants  of  places  where  the  cessation  occurs,  or  of  those 
situated  beyond  that  limit,  continue  to  suffer  from  thoracic  inflam 
mation,  just  as  extensively  and  severely  as  those  below,  if,  indeed, 
they  do  not  to  a  greater  extent.  "While  fevers,  whatever  be  the 
elevation  above  the  level  of  the  sea  at  which  they  prevail,  make 
their  appearance  principally  in  the  localities  specified,  and  seldom, 
except  under  special  circumstances,  break  out  in  high  and  well-aired 
situations,  pneumonia,  though  not  a  stranger  to  low  grounds,  val 
leys,  and  the  like,  prevails  as  widely,  if  not  more  so,  on  mountains, 
hills,  and  other  similar  spots.  To  prove  this  by  a  reference  to  a 
6 


82  PNEUMONIA    AND 

large  number  of  examples,  would  be  a  work  of  supererogation; 
for  there  can  scarcely  be  found  a  physician  who  is  not  perfectly  con 
versant  with  the  fact.  We  know  how  subject  the  low  grounds  and 
miry  river  banks  of  Africa  are  to  fever.  On  elevated  localities, 
which  in  some  places  are  comparatively  free  from  that  disease,  the 
inhabitants  are  sufferers  from  pneumonia.  This  is  the  case  in  the 
island  of  Fernando  Po,  and  other  places.1  Grisolle,  though  not 
prepared  to  admit  the  injurious  ejects  of  great  terrestrial  altitude 
in  the  production  of  pneumonia,  cites  the  instance  of  a  body  of 
French  troops  encamped  from  the  15th  of  December  to  the  15th  of 
May,  on  Mount  Cenis,  where  malarial  fevers  are  not  common,  if  at 
all  known.  Among  these  troops,  pneumonia  constituted  one-fourth 
part  of  the  disease!  from  which  they  suffered.2  During  the  year 
1850,  pneumonia  in  children  prevailed  to  a  considerable  extent  in 
all  its  various  forms  in  West  Philadelphia.  Dr.  Pugh,  who  reports 
the  occurrence,  adds :  "  And  I,  think  I  may  ^ay,  at  least  as  far  as 
my  practice  or  knowledge  extended, ''that  tjie1  disease  was  not  in 
fluenced  by  locality,  but  was  quite  as  common  on  high  as  low 
grounds."  The  same  physician  remarks*- that  fever  in  the  same 
season  extended  from  the  locks  of  the  Schuylkill  Navigation  Com 
pany  to  Chestnut  Street,  and  about  five  squares  West  of  Market 
Street  Bridge.  "  I  think  it  may  be  asserted  with  safety  that  the 
farther  we  go  West,  or  the  more  elevated-* the  ground  becomes,  the 
less  of  that  malady  will  be  found."3  Here  then  we  see,  in  the  one 
case,  pneumonia  prevailing  most  extensively  on  one  of  the  highest 
ridges  of  the  Alps,  where  fever  does  not  appear,  and  in  the  other, 
while  fever  ceases  in  proportion  as  we  ascend  from  the  Schuylkill, 
pneumonia  is  not  influenced  in  its  frequency  by  the  change  of  lo 
cality.  Not  different  are  the  results  obtained  in  other  elevated  and 
mountainous  regions  of  this  country.  "  The  elevation  and  coolness 
of  the  Alleghany,"  says  another  reporter,  "  secures  the  inhabitants 
entirely  from  the  fevers  peculiar  to  those  of  the  first-mentioned 
division  (that  comprising  low  alluvial  land,  bordering  the  Juniata 
River),  while  they  suffer  most  from  those  of  a  pleuritic,  pneumonic, 
and  rheumatic  character."4 

Dr.  Williams5  remarks :  "  Elevated  districts  are  perhaps  the  more 

1  Daniel,  Topogr.  and  Dis.  of  Guinea,  137-453. 

2  P.  135. 

3  Transact,  of  Pa.  State  Mod.  Soc.  i.  47. 

4  Rep.  of  the  Blair  Cy.  Med.  Soc.  Tr.  St.  Med.  Soc.  i.  105. 
«  Cyclop,  of  Pract.  Med.  3,  407. 


AUTUMNAL    FEVERS.  83 

liable  to  pneumonia  because  they  are  more  exposed  and  colder, 
whereas  the  humid  air  of  low  valleys,  while  it  diminishes  the  inten 
sity  of  the  cold,  relaxes  more  the  mucous  surfaces,  and  renders  them 
the  weaker  points  of  the  circulation." 

$• 

7.  Fevers  influenced  by  nature  of  soil — not  so  pneumonia,. — Autumnal 
or  periodic  fevers,  as  every  medical  inquirer  must  know,  are  found 
to  originate  mostly,  if  not  exclusively,  in  localities  the  soil  of  which 
presents  peculiar  geological  characters,  and  is  composed,  in  great 
part  at  least,  of  organic  elements  of  a  particular  kind,  or  contains 
on  its  surface,  or  at  a  short  distance  beneath,  substances  more  or 
less  foreign  to  its  composition,  but -giving  rise,  when  acted  upon  by 
certain  thermometrical,  hygrometrfcal,  and  ottter  influences,  to  the 
evolvement  of  poisonous  exhalations.     Experience  has  shown,  also, 
that  the  cause  of  such  fevers,  whatever  be   its  nature,  possesses 
different  degrees  of  affinity  for  the  many  substances  over  which  it 
passes  when  wafted  Tfe  aerial  currents ;  that  tbese  substances  act,  as 
it  were,  as  so  many  attracting  or  repelling  causes,  tending  to  limit  or 
extend  the  sphere  of  its  morbid  agency ;  and  that  hence  while 
fever,  the  efficient   cause  of  which  is  evolved  at  some  distance, 
abounds  on  a  given  stratum  of  soil,  it  spares  individuals  residing 
on  strata  of  a  different  character.     What  the  peculiarities  of  locali 
ties  thus  afflicted  are,  wili  be  stated  in  a  subsequent  part  of  these 
inquiries.     Suffice  it  here  to  say,  that,  wherever  they  are  found  to 
exist,  hygrometrical,  thermometrical,  and  other  influences  aiding, 
fevers  will  also  be  found  to  originate,  and  often  to  abound.     As 
regards  pneumonia,  I  am  not  aware,  and  greatly  doubt,  that  any 
facts  entitled  to  our  respect  have  as  yet  been  pointed  out  calculated 
to  connect  the  origin  or  prevalence  of  the  disease  with  any  geologi 
cal  formation,  the  peculiar  composition  of  the  soil,  or  the  particular 
substances  which  may  be  spread  on  or  placed  beneath  the  surface 
of  the  latter. 

8.  Fevers  arrested  by  frost — not  so  pneumonia. — Nor  is  it  less  essen 
tial  to  remark,  in  opposition  to  the  views  under  examination,  and 
in  support  of  those  here  maintained,  that  in  places  where  malarial 
fevers  prevail  during  a  certain  period  of  the  year,  they  are  almost 
suddenly  put  a  stop  to,  whatever  be  their  forms  or  types — inter- 
mittents,  remittents,  and  yellow — by  the  advent  of  frost.    After  the 


84  PNEUMONIA    AND 

occurrence  of  the  latter,  localities  which  before  were  unhealthy — 
to  such  an  extent  as  not  to  be  visited  with  impunity,  especially  at 
night — become  free  from  suph  fevers,  and  from  all  diseases  of  a 
malarial  origin. 

Now,  as  by  the  thermometric  change  in  question,  the  morbid 
agent  that  had  given  rise  to  totumnal  fevers  has  been  destroyed, 
as  proved  by  the  cessation  of  its  legitimate  effects,  and  as,  while  this 
takes  place  in  regard  to  fever,  pneumonia  is  undisturbed  as  to  its 
prevalence,  or,  indeed,  is  even  increased  in  point  of  frequency,  it  is 
natural  to  conclude  that  the  cases  of  pneumonia  which  continue  to 
show  themselves  as  heretofore,  after  the  occurrence  of  that  change, 
cannot  be  referred  to  the  baneful  agency  of  the  cause  in  question, 
but  are  due  to  the  operation  of  some  other  morbific  influence,  over 
which  frost  exercises  no  control,  and  differing,  consequently,  in  its 
nature,  from  the  former.  If  we  admit  t^ig,  w^jfe, cannot  err  in  admit 
ting,  also,  .that  the  same  causes  which  gave  ris^  to  cases  of  pneumo 
nia,  occurring  after  a  stop  has  -be.en  put  to  autumnal  fevers  by  frost, 
must  have  occas!(kied  the  case»of  that  disease(,^Jbserved  during  the 
'prevalence  of  such  fevers  and  anterior  to  the  advent  of  frost.  If  the 
cause  which  produced  pneumonia  after  that  event  must,  for  reasons 
stated,  differ  essentially  from  that  occasioning  the  fevers  whose 
career  has  thus  been  arrested,  the  cause  giving  rise  to  the  cases  that 
appeared  during  the  fever  season  must  alsb  be  different  from  the 
febrile  poison;  and  we  hence  arrive  at  *$ie  conclusion,  already  ad 
verted  to,  that,  when  the  two  diseases  show  themselves  together  in 
the  same  place,  two  different  sets  of  causes  are  at  work,  and  from 
this  difference  of  cause  we  have  reason  to  infer  the  existence  of  a 
difference  in  the  nature  of  the  diseases  produced ;  and  that,  when 
pneumonia  is  followed  by,  or  succeeds  to,  fevers,  it  is  not  influenced 
in  its  production  by  the  causes  to  which  these  are  due. 

I  am  not  ignorant  of  the  fact  that  the  salutary  effects  here 
ascribed  to  frost,  of  putting  a  stop  to  autumnal  fevers,  has  been  called 
in  question.  I  am  aware  that,  in  proof  of  the  fallacy,  it  is  remarked 
that  such  fevers  are  encountered  every  month  of  the  year ;  that 
they  prevail,  more  or  less,  all  the  year  round ;  and,  consequently,  I 
am  prepared  to  be  met  with  the  objection  that,  such  being  the  con 
tinued  prevalence  of  the  disease,  in  cold  as  well  as  in  warm  weather, 
any  argument  against  the  etiological  and  pathological  connection  of 
pneumonia  with  autumnal  fevers,  founded  on  the  supposed  cessation 


AUTUMNAL    FEVERS.  85 

of  the  latter  through,  the  effect  of  a  reduction  of  atmospheric  tem 
perature  to  the  freezing  point,  must  be  set  aside. 

How  far  such  an  objection  will  infh^ence  those  who  have  paid  due 
attention  to  the  subject,  I  need  not  inquire.  Having,  however,  ad 
duced  the  fact  of  that  cessation,  as  one  well  established  and  militating 
strongly  against  the  views  under  examination,  I  must  be  allowed 
to  show,  were  it  only  for  the  benefit  of  those  who  venture  on  the 
denial,  that  what  I  have  said  in  the  matter  is  not  a  dream  of  the 
imagination — "  a  sheer  assumption,  worthy  of  one  who  is  behind 
the  times" — but  has  received  the  sanction  of  the  highest  medical 
authorities,  in  all  parts  of  the  world.  Now,  that  in  hot  or  very  mild 
climates,  malarial  fevers  may,  and  often  do,  continue  to  prevail, 
more  or  less,  all  the  year  round,  is  a  position  which,  as  every  one 
conversant  with. the  subject  knows,  will  admit  of  no  doubt.  But  the 
fact  of  such  a  contiiiuariicp  of  the  disease  in  those  climates  does 
not  in  any  way  impaj^  th^' correctness  of  the  statement  made  re 
specting  the  aforesaid  power  of  fro^t ;  the  explanation  of  the  differ 
ence  being  easily  foiyad  in  the  circumstance,  that'  in  those  climates 
the  cold  of  winter  does  not  prevail  in  sufficient  force,  or  continue 
long  enough,  to  produce  the  effect  contended  for,  and  decided  frost 
never  or  seldom  occurs  at  all.  But,  be  this  as  it  may  in  regard  to 
the  climates  mentioned,  it  is  indubitably  true,  that  whenever,  in  a 
miasmatic  district,  the  tnermometer  descends  to  the  freezing  point, 
and  there  remains  awhile, 'the  progress  of  malarial  fever  is  arrested. 
In  this  vicinity,  among  others,  every  one,  from  the  learned  physician 
to  the  gossiping  granny,  knows  full  well  that  the  accession  of  severe 
cold  weather,  and  particularly  of  black  frost,  is  sure  to  be  marked 
by  a  cessation  of  the  fevers  in  question,  and  that,  in  the  few  cases 
that  present  themselves  after  that  event,  the  attack  is  ascribable  to 
that  power  of  dormancy,  by  virtue  of  which  the  cause  of  some 
diseases  remains,  for  a  greater  or  less  length  of  time,  latent  in  the 
system  after  exposure,  and  which,  in  some  forms  of  fever,  may  be 
prolonged  for  weeks  and  even  months.  Had  I  space  and  leisure  to 
enlarge  much  on  this  subject,  and,  indeed,  were  it  necessary,  I 
could  demonstrate,  by  means  of  numerous  quotations,  that  such  is 
the  case  also  in  other  parts  of  this  country,  and  in  foreign  lands — 
in  every  place,  indeed,  where  the  cold  of  winter  is  well  marked  or 
the  frost  severe.  A  few  references  will  be  sufficient.  Thus,  in 
regard  to  periodical  fevers,  the  fact  of  their  cessation,  through  the 
effect  of  cold  or  frost,  is  recorded  in  the  writings  of  the  physicians 


86  PNEUMONIA    AND 

of  our  northern  and  middle  States,  and  .of  Canada:  Eush,1  Currie,2 
Potter,3  Caldwell,4  E.  II.  Smith,5  J.  M.  Smith,6  Wood,7  Coventry,8 
Vaughan,9  Lee,10  Usher  Parsons,11  Agnew,12  Lucas,13  Stratton.14 
In  the  South,  South-west,  and  West,  we  find  it  mentioned  and  in 
sisted  upon  by  Taylor,15  Eamsay,16  Hansford,17  Thompson,18  Wa 
ring,19  Arnel,20  Prior,21  Smelt,22  Dunbar,23  Staley,24  Dickson,25  Hil- 
dreth,26  Drake,27  Simons,28  Grant,29  Cooke.30  Cross  we  the  Atlantic, 
we  find  the  same  thing  taught  by  Sydenham,31  Lancisi,32  Cleghorn,33 
Bartholin,34  Bancroft,36  Williams,36  Copland,37  Macculloch,38  Monfal- 
con,39  Eigaud  de  Lisle,40  E.  Hamilton,41  Sir  J.  Pringle,42  F.  Home,43 
G.  Brown,44  Tournon,45  Bailly,46  Sir  Ch.  Morgan,47  Sir  James  Clark,48 
Booth,49  Carriere,50  De  Eenzi,51  Jacquot.52  In  fact,  it  is  mentioned 

1  Non.  Cont.  of  Yellow  Fever,  Med..  Repos.  vi.  162. 

2  On  Bilious  Fever,  13,  21 ;  Med.  and  Philos.  Register,  i.  181,  195. 

3  On  Contagion,  16. 

4  On  Miasma, J6;   Med.  and  Phys.  'Mem.  fl800),  2%. 

5  Webster's  (||lle$fcion,  107.  6  On  Epidemics,  71. 

7  Pract.  of  Med.  i.  142,  267. 

8  On  Lake  Fever,  N.  Y.  Med.  and  Phys.  J.  in.  15;   Tr.   of  Med.  Soc.  of  the  State 
of  N.  Y.  for  1825,  42. 

9  Med.  Repos.  iv.  130.  10  Med.  Repos.  iii.  252. 

11  On  Malaria  (Essays),  200.  12  Med.  Recorder,  vi.  138. 

13  Med.  Recorder,  v.  420.  14  Edinb.  Med.  and  Surg.  J.  Ixiv.  105. 

15  Webster's  Collection,  148.  16  History  of  South  Carolina,  ii.  55-6. 

17  Webster's  Collection,  148.  18  Chapman's  Journal,  x.  106. 

19  N.  A.  Med.  and  Surg.  J.  i.  5 ;  ix.  375.       »  Med.  and  Philos.  Register,  ii.  10. 

21  In  Potter,  op.  cit.  16.  »  Med.  Repos.  ix.  127. 

23  Med.  Repos.  viii.  258.  **  Med.  Recorder,  v.  460. 

25  Am.  J.  ii.  64. 

26  Med.  Repos.  xi.  345;  Chapman's  J.  ix.  109. 

27  Topog.  and  Dis.  of  the  Valley  of  the  Miss.  608,  713. 

28  Charleston  J.  iv.  543.  »  Am.  J.  July,  1853,  112. 
30  Med.  Record,  vii.  453.                                31  Works,  ii.  191. 

32  De  Noxiis  Paludum  Effluviis,  46.  33  Dis.  of  Minorca,  133. 

34  Hist.  Anatomicarum,  72. 

35  Tr.  on  Yellow  Fever,  292,  407;  Sequel  to  do.  91. 

36  On  Morbid  Poisons,  ii.  460.  «  Vol.  i.  759;  ii.  1100. 

38  On  Malaria,  155.  39  Traite"  des  Marais,  345. 

40  In  Johnson  on  Trop.  Cl.  313.  41  On  Marsh  Remit.  Fever,  28,  32. 

42  Dis.  of  the  Army,  14,  116,  172.  43  Med.  Facts  and  Observations,  46,  76. 

44  Cyclop,  of  Pract.  Med.  ii.  235.  45  Etudes  sur  Rome,  i.  203. 

46  Traite  des  F.  Int.  Pernicieuses,  134.  47  Lady  Morgan's  Italy,  i.  439,  ii.  106. 

48  Med.  Notes  on  Italy,  80-3. 

49  Life  of  Dr.  Armstrong,  i.  258,  ii.  295,  597. 

50  Du  Climat.  de  1'Italic,  371. 

51  Oss.  Sulla  Topog.  Med.   del  Regno  di  Napoli,  68;   Miasmi  Paludosi,  21. 

52  Des  F.  a  Quinquina,  38. 


AUTUMNAL    FEVERS.  87 

as  a  well-known  and  indisputable  phenomenon,  by  all  who  have 
written  on  the  periodic  fevers  of  England,  Holland,  Flanders, 
France,  Italy,  Spain,  etc.  Nay,  in  the  West  Indies  themselves,  the 
healthy  season  is  the  cool  season,  and  the  continuance  of  periodic 
fevers  during  the  winter  months  is  in  direct  proportion  to  the  con 
tinuance  of  heat.  In  warm  winters  fever  continues;  in  cool  ones  it 
disappears  in  great  measure,  or  completely.  The  researches  of  Dr. 
Drake,  in  reference  to  the  Valley  of  the  Mississippi,  show  that,  with 
the  decrease  of  yearly  and  summer  heat,  other  conditions  continuing 
unchanged,  there  is  an  abatement  of  the  fever ;  that  a  summer  tem 
perature  of  60°  is  necessary  to  the  production  of  fever,  and  the 
latter  will  not  prevail  as  an  epidemic  when  the  temperature  of  that 
season  falls  below  65°;  finally,  that  if  the  other  conditions  favour 
ing  its  production  are  deficient,  it  will  cease  before  those  reductions 
of  temperature  have  bee^n  reached.  "According  to  these  conclu 
sions,  the  fever  will  occ^r  in  winter,  at  all  places  where  that  season 
has  a  mean  temperature  of  60°  or.  upwards,  as  at  $T.Q$jjl  Cruz,  Tam- 
pico,  Havana,  Key  West,  Tampa  Bay  and  Fort  King,  and  it  is  well 
known  that  cases  do  occur  at  those  places,  in  that  season ;  but  in 
other  places,  where  the  winter  heat  barely  rises  over  60°,  they  are 
few  in  number.  At  New  Orleans,  and  generally  under  the  30th 
parallel,  where  the  mean  winter  heat  is  as  low  as  50°,  the  fever  is 
suspended." 

Dr.  Drake  farther  says:  "But  the  seasons  are  made  up  of  months, 
and  we  are  here  brought  to  consider  its  connection  with  their  re 
spective  temperatures.  Up  to  Tampa  Bay,  every  winter  month 
rises  above  60  degrees ;  but  at  New  Orleans,  or  the  30th  parallel, 
only  the  nine  months  from  March  to  November  have  that  tempe 
rature  ;  and  as  we  advance  to  the  north,  the  number  of  months  hav 
ing  it  constantly  decreases.  Thus,  at  St.  Louis,  it  is  attained  by 
five  months  only,  from  May  to  September  inclusive ;  at  Fort  Snel- 
ling,  by  four;  at  Fort  Brady,  by  three;  at  Montreal,  by  four;  at 
Quebec,  by  three.  In  advancing  farther  north,  June  and  Septem 
ber  fall  below  it ;  and  finally,  in  the  distant  north,  July  and  August, 
or  the  entire  year.  Long  before  this  reduction  is  reached  by  those 
two  months,  however,  the  fever  ceases ;  and,  therefore,  it  results 
that  a  continuance  for  more  than  two  months  of  a  heat  equal  to  60 
degrees  is  necessary  to  the  development  of  the  fever."  "  It  appears, 
from  all  that  has  been  said,  that  within  the  tropics  autumnal  fevers 
occur  throughout  the  year,  and  that,  as  we  move  northerly,  the 


88  PNEUMONIA    AND 

duration  of  its  prevalence  shortens,  by  it$  beginning  later  in  spring, 
and  terminating  earlier  in  autumn.  March  and  November  first 
escape,  then  April  and  May  on  the  one  hand,  and  October  on  the 
other — lastly,  June  and  September."1 

So  much  for  endemic  periodic  fever.  If  we  turn  to  the  yellow 
fever,  we  shall  find  that  kindred  results  are  obtained.  That  in 
some  sickly  seasons,  in  this  part  of  the  country  as  well  as  in  Eu 
rope,  cases  are  sometimes  met  with  several  days,  or  (as  in  the 
South)  some  weeks  after  cold  weather  has  set  in,  is  true.  But  such 
results  are  rare,  in  the  North  particularly ;  and  they  are  most  gene 
rally  the  effect  of  the  breaking  out  of  the  disease  in  persons  who 
had  imbibed  the  seeds  of  it  prior  to  the  fall  of  the  thermometer. 
But  here  as  elsewhere — at  the  North  and  the  South — the  disease 
invariably  ceases  as  an  epidemic,  after  a  frost  sufficiently  severe  to 
kill  the  leaves  of  trees  and  annual  plants. 

Dr.  Kush,2  speaking  of  our  yellchy  fever,  says :  "  It  is  completely 
destroyed  by  frost."  Dr.  Cufrie3  remarks,  in  reference  to  the  epi 
demic  of  1793 :  "  AS  the  weather  became  cold  and  frosty,  its  declen 
sion  was  so  rapid  that  it  appeared  as  if  extinguished  by  a  miracle." 
In  1797,  the  Academy  of  Medicine4  derived  an  argument  in  favor 
of  the  identity  of  yellow  and  bilious  fevers,  from  the  fact  that  they 
were  both  uniformly  checked  and  destroyed  by  the  same  causes — 
heavy  rains  and  frost.  And  if  the  reader  will  examine  the  records 
of  all  the  other  epidemics  by  which  this  city  has  been  visited — those 
of  1699,  1741,  1747,  1794,  1797,  1798,  1799,  1805,  and  1820— he 
will  find  that  they  were  all  put  a  stop  to,  more  or  less  suddenly,  by 
the  occurrence  of  similar  changes  of  temperature. 

Drs.  Harrison,5  Thomas,6  Gros,7  etc.,  of  New  Orleans,  inform  us 
that  the  fever  of  that  city  ceases  as  an  epidemic  after  the  occurrence 
of  frost.  Drs.  Moultrie,8  Lining,9  Campbell,10  Chalmers,11  Ramsay,12 
Harris,13  of  Charleston,  tell  us  much  the  same  thing,  relative  to 

1  Drake,  714. 

2  Facts  intended  to  prove  the  Yellow  Fever  not  to  be  contagious,  Works,  iv.  155. 
See  also  vol.  iii.  98-9,  100,  201 ;  vol.  iv.  8,  45,  95. 

3  P.  2. 

4  Letters  to  the  Governor  of  Pensylvania,  etc.  3. 

5  Remarks  on  the  Yellow  Fever,  New  Orleans  Journal,  Sept.  1845,  130. 

6  Essai  sur  la  F.  J.  d'Amerique,  110. 

7  llapport,  etc.  6,  01.  8  French  Translation,  5. 
9  Essays  and  Observations  of  Edinb.  ii.  409.          I0  See  Watts,  249. 

11  Climate  of  S.  C.  ii.  00.  12  Med.  Kepos.  iv.  219. 

13  Barton's  Journal,  ii.  29. 


AUTUMNAL    FEVERS.  89 

the  fever  of  that  city,  which  invariably  ceases  on  the  accession  of 
frost  or  severe  cold.  Nor  do  we  find  matters  take  a  different 
turn  in  that  respect  at  Natchez.  Of  the  epidemic  of  1817,  we  are 
told  by  Dr.  Perlee,1  that  "  on  the  9th  of  November  there  occurred 
a  severe  frost,  which  at  once  arrested  its  progress,  and  permitted 
the  inhabitants  to  return  in  safety  to  their  homes." 

The  same  writer,  in  his  account  of  the  epidemic  of  1819,  informs 
us  that  the  weather  became  cool  in  the  middle  of  November,  and 
the  disease  began  to  subside.  About  the  first  of  December,  there 
having  been  a  moderate  frost,  the  Board  of  Health  quickly  informed 
the  inhabitants  that  they  could  return  to  their  homes  with,  a  reason 
able  prospect  of  safety.2  In  reference  to  the  epidemic  of  1823, 
the  most  disastrous  by  which  that  city  was  visited,  Dr.  Merrill 
remarks:  "During  the  night  of  the  31st  of  October,  a  very  great 
change  took  place  in  the  weather.  .  The  wind  changed  suddenly 
from  the  south  to  the  north-west,  \ud  th^  thermometer  fell  from 
78  to  28  degrees  in  about  sixteen  hours.'*  On  the  1st  of  November 
it  was  considered  safe  to  return  to  the  city."3  In  testimony  of  the 
salutary  effect  of  frost  on  that  occasion,  we  have  the  farther  autho 
rity  of  Dr.  Monette.4  In  1825,  the  disease  continued,  with  little 
abatement,  until  the  26th  of  October,  when,  as  Dr.  Merrill5  states, 
"  we  had  a  heavy  shower  of  rain.  The  next  day  the  wind  changed 
to  north-west,  and  blew  strong  and  cold,  and  during  the  succeeding 
night  the  thermometer  fell  to  34  degrees,  which  induced  many  fami 
lies  to  return  to  the  city."6  Dr.  Monette  also  remarks  that  the  dis 
ease  continued  its  ravages  until  checked  by  frost  and  cold  weather, 
about  the  28th  of  October.7  From  the  same  writer  we  learn  that, 
in  1837,  "the  disease  continued  to  spread  gradually,  and  with  occa 
sional  abatements,  until  checked  by  frost,  about  the  25th  of  Novem 
ber."8  It  may  not  be  improper  to  remark  that  Dr.  Merrill  says,  in 
relation  to  Memphis,  that  if  the  grading  there  "has  fallen  short  of 
creating  an  epidemic  of  quite  as  grave  a  character  as  similar  causes 
have  elsewhere,  it  may  be  owing  to  the  modifying  influences  of  a 
few  timely  showers  of  rain  or  an  early  frost."9  I  have  now  before 

1  Philad.  Med.  and  Phys.  Journ.  iii.  6.      2  Ibid.  10. 
3  Ibid.  ix.  255.  4  Observations,  65. 

5  Ibid.  Essay,  59.  6  ^    A.  Med.  and  Surg.  Journ.  ii.  220. 

7  Essay,  02  ;   Observ.  67.  8  Observations,  70 ;   Essay,  75. 

9  Public  Address  on  the  Health  and  Mortality  of  Memphis,  Memphis  Medical  Re 
corder,  i.  90. 


90  PNEUMONIA    AND 

me  a  list  of  about  ninety  good  and  substantial  authorities,  who 
describe  the  yellow  fever  as  it  has  appeared  epidemically  in  Boston, 
Xew  York,  Providence,  Wilmington,  Baltimore,  Norfolk,  Frank 
lin,  Vicksburg,  Alexandria,  Galliopolis,  Gibraltar,  Barcelona,  Ca 
diz;  who  all,  like  the  authorities  already  mentioned,  in  connection 
with  the  disease  as  it  has  shown  itself  in  this  city,  New  Orleans, 
Charleston,  and  Natchez,  impart  to  us  information  which  I  recom 
mend  to  the  particular  notice  of  those  who  deny  the  destroying  and 
purifying  agency  of  frost,  of  severe  cold,  or  blasts  of  northerly 
winds.1  I  must  also  recommend  to  their  attention  those  instances, 

1  Dalmas,  39;  Caldwell  (Fever  of  1805),- 51;  Ibid.  Memoirs  (1800),  200;  ditto  of 
1826,  124;  Bally,  313,  314;  Campbell,  in  Watts's  Med.  and  Surg.  Reg.  249;  Moul- 
trie,  French  Trans.  5;  Monette,  1st  edit.  50,  60,  G3  ;  Ibid.  2d  edit,  7,  63,  65,  67,  70; 
Thomas,  110,  2d  edit.  14 ;  Potter  on  Contagion,  25  ;  Osgood,  17  ;  Hosack,  Febrile  Con 
tagion,  10;  Facts,  etc.,  by>the  College  of  Phys.  4;  Diet,  des  Sc.  Med.  xv.  357; 
Davidge,  69 ;  Caisergue,  194;  YalentiA,  88 ;  ^Harrison,  New  Orleans  Journ.  ii.  130; 
Chalmers,  Climate  of  South 'Carolina,  ii.  60;  Bancroft,  292,  407,  425;  Ibid.  Sequel, 
89,  91  ;  Selden  and  Whitehead,  Med':  Repos.  iv.  129,  836  ;  Chisholm,  Letter  to  Dr. 
Hay-garth,  177;  Currie,  Med.  Register,  i.  181  ;  "Report  of  Philad.  Acad.  of  Med,  7; 
Med.  Rep.  i.  406;  Hardi£,  Fever  of  New  York  in  1798,  13  ;  Ibid.  1822,  67,  68;  Con- 
die  and  Folwell,  Fever  of  Philadelphia  in  1798,  81 ;  Currie,  Fever  of  1799,  25 ;  Ibid. 
on  Bilious  Fever,  15;  Halphen,  62;  Brown  (S.),  26,  108;  Pierquin,  40,  60;  Townsend 
On  Black  Vomit,  30;  Ibid.  Fever  of  New  York  in  1822,  257-8;  Palloni,  Sulla  Febbre 
Gialla,  etc.  20;  Dariste,  31 ;  Jackson  (Sam.),  Fever  of  Philadelphia  in  1820,  24;  Let 
ters  on  the  Fever  of  Baltimore  in  1819,  80,  113;  Addom's  Dissertation,  7;  Hosack's 
Essays,  i.  292;  Shecut,  94,  100;  Copland,  iii.  169;  Report  on  Fever  of  N.  0.  in  1820, 
6  ;  New  York  Report  of  Quarantine,  44 ;  Stone,  New  Orleans  Journ.  ii.  551 ;  Pym,  2, 
8,  216;  Ibid.  2d  edit,  2,  65;  Smith  (J.  M.),  81,  90,  91 ;  Burnett  (Sir  W.),  342  ;  Blane, 
(Sir  G.),  Dissertations,  ii.  152,  155;  Caillot,  107;  Barton  (Ed.),  Fever  of  New  Orleans 
in  1833,  6,  9;  Chervin,  Report  on  Mem.  by  Rufz,  77;  Ibid.  Letter  to  Monfalcon,  17, 
18;  Forry,  Climate  of  U.  S.  290;  Bayley,  Letters  from  Health  Office,  9;  Amicl  in 
Johnson  on  Trop.  Cl.  270 ;  Ibid.  Edinb.  Med.  and  Surg.  Journ.  xxxv.  276 ;  Robert, 
Guide  Sanitaire,  i.  43;  Physical  Inquiry,  etc.  (N.  Y.),  25;  Gillkrest,  Cyclop,  of  Pract, 
Med.  ii.  279  ;  Lining,  Edinb.  Essays,  ii.  409  ;  Smith,  Edinb.  Med.  and  Surg.  Journ. 
xxxv.  40;  Wood,  i.  296;  Chapman,  Med.  and  Phys.  Journ.  ix.  135;  Merrill,  ibid.  ix. 
255 ;  Ibid.  North  Am.  Med.  and  Surg.  Journ.  ii.  220 ;  Townsend  on  Plague  and  Yel 
low  Fever,  New  York  Journ.  ii.  46 ;  Emlen,  N.  A.  Mod.  and  Surg.  Journ.  v.  328 ; 
Humboldt's  New  Spain,  ii.  765;  Fever  of  New  York  in  1805,  Med.  Repos.  ix.  213; 
Yaughan,  Fever  of  Wilmington,  12,  20;  Wheaton,  Med.  Rcpos.  x.  335;  Harris 
(Tucker),  Barton's  Jounr.  ii.  29;  Monro,  Med.  Repos.  iii.  136;  Ramsay,  ibid.  iv.  219; 
Seaman,  ibid.  iv.  249;  Opinion  of  the  Medical  Faculty  of  Baltimore  on  Fever  of  1800, 
Med.  Repos.  iv.  353;  Archer,  Med.  Recorder,  v.  61  ;  Bond  (Thomas),  Lecture,  N.  A. 
Journ.  iv.  271;  Deveze,  197;  Brent,  Med.  Repos.  ii.  390;  Rayer,  Fever  of  Barcelona, 
43,  48;  Audouard,  414;  Pariset,  Relat.  Hist.  93;  Miller  (Kdw.),  Rep.  88,  106; 
O'lFalloran,  118:  Drake,  608;  Reese  (Meredith),  Observations  on  the  Epidemic  of 
1819,  as  it  appeared  in  a  part  of  the  city  of  Baltimore,  46. 


AUTUMNAL    FEVERS.  91 

not  difficult  to  be  found,  of  vessels  infected  with  yellow  fever,  and 
which  have  been  rendered  healthy,  often  rapidly,  on  reaching  a  cold 
climate,  and  passing  through  the  ordeal  of  frosty  weather.1 

"  In  the  event  of  a  ship's  company  being  attacked  by  fever,"  says 
Dr.  Bryson  (227),  "whether  from  external  or  internal  causes,  which 
shows  a  disposition  to  become  general,  and  to  assume  a  malignant 
form,  characterized  by  intensity  of  action,  early  yellowness  of  the 
skin,  and  black  vomit,  it  will  be  of  the  greatest  importance  for  the 
safety  of  all  on  board,  that  she  should  immediately  quit  the  locality 
where  the  disease  originated,  and  proceed,  with  all  possible  haste, 
to  some  colder  region ;  if  in  the  south,  to  the  southward,  and,  if  in 
the  north,  to  the  northward,  avoiding  the  neutral  ground  between 
the  trade  winds.  The  great  utility  of  this  measure  was  practically 
tested  by  the  Yqstal  in  1885,  when  her  crew  were  assailed  by  fever 
at  Port  Royal,  in  Jamaica,  which  dijj  not  cease,  although  she  was 
shifted  from  the  inside  to  the  keys* on  the  -outside  of  the  harbor, 
nor  until  after  she  had^gone  far  Beyond  the  precincts  of  the  island, 
and  entered  the  twenty-sevenih  degree  of  north  latitude  on  her  way 
to  Bermuda.  The  crew  of  the  same  vessel,  although  not  the  same 
men,  after  having  been  paid  off  and  recommissioned,  were  again 
violently  attacked  by  fever  whilst  cruizing  among  the  windward 
islands  of  the  West  Indies  in  the  latter  part  of  1839.  Instead  of 
running  at  once  to  the  northward,  she  proceeded  to  Carlisle  Bay, 
where  she  remained  about  a  fortnight ;  during  that  time  the  disease 
evidently  increased  in  malignancy,  and  carried  off  a  considerable 
number  of  men.  She  was  then  directed  to  proceed  to  the  north 
ward,  and  again  the  disease  disappeared  a  few  days  after  she  had 
crossed  the  tropics.  The  ship's  company  of  the  Vesuvius  were 
promptly  relieved  of  an  invasion  of  fever  by  her  being  ordered 
from  Sacrificios,  where  it  was  contracted,  to  Halifax." 

These  facts,  observed  in  such  divers  places,  and  attested  by  so 
many  respectable  and  even  eminent  authorities,  and  which  ought 
to  be,  and  I  have  little  doubt  are,  familiar  to  the  disbelievers  in  the 
efficacy  of  frost  in  arresting  the  progress  of  malarial  fevers,  taken 
in  connection  with  the  statements  made  by  Humboldt,  in  reference 
to  Yera  Cruz,  that  the  vomito  or  yellow  fever  seldom  begins  to 

1  Trotter,  i.  357;  Caillot,  114;  Doughty,  25;  Ferguson's  Rccol.  143;  Keraudren, 
18;  Pym,  2cl  edit.  Go,  127  ;  Bryson,  Report  on  the  Climate  and  Principal  Diseases  of 
the  African  Station,  50;  Barrington,  Am.  Journ.  xii.  309;  Waring,  Med.  Repos.  iv. 
1,  234;  Allan,  Edinb.  Monthly  Journ.  xi.  32<>.  See  also  cases  of  the  Gen.  Green,  Med. 
Reposit.  iv.  1,  234  ;  of  the  U.  S.  Ship  Hornet,  Am.  Journ.  xii.  307. 


92  PNEUMONIA    AND 

prevail  there  before  the  average  temperature  of  the  early  months 
reaches  to  .twenty-four  degrees  of  centigrade  thermometer  (75.2 
degrees  of Fahr.) ;  that  in  December,  January,  and  February,  when 
the  heat  remains  below  that  limit,  and  the  cold  is  often  very  sharp, 
the  disease  usually  disappears  completely ;  that  the  latter  declines 
sometimes  very  suddenly,  through  the  effects  of  the  north  winds 
(los  nortes),  an  observation  also  made  in  more  southern  climates  ;l 
that  the  later  these  continue  to  blow  in  the  spring,  the  later  the 
fever  makes  its  appearance ;  and  the  sooner  they  commence  in  the 
autumn,  the  less  apprehension  is  felt  respecting  its  continuance  ;2 
all  this,  I  say,  should  suffice  to  carry  conviction  to  all  unprejudiced 
minds.  * 

Nay,  more,  it  may  be  mentioned,  in  farther  corroboration  of  what 
precedes,  that  the  history  of  the  Oriental  Plague,  whatever  may 
have  been  its  course  in  some  places,  and  under  special  circum 
stances — as,  for  example,  at  Aleppo — whatever  may  be  the  usual 
order  of  events  in  Egypt  and  Smyrna,  and  however  the  disease 
may  have  comported  itself  during  casual  epidemics  in  other  cities 
of  Europe  and  Asia,  furnishes  additional  illustrations  of  the  power 
of  cold  and  frost,  in  checking  the  progress  of  malarial  complaints, 
among  which  that  disease  must  undeniably  be  classed. 

The  epidemic  of  London,  in  1665,  was  arrested  in  December  by 
frost.3  "  Like  everything  else,  too,  in  nature,"  says  Sydenham,  in 
speaking  of  the  plague,  "  it  has  its  proper  ^periods  of  increase  and 
decline ;  it  takes  birth  at  the  period  given  above  (when  spring 
passes  into  summer),  and  it  rises  towards  maturity  as  the  year  ad 
vances  ;  with  the  decline  of  the  year  it  declines  also.  Finally,  the 
frosts  of  winter  transform  the  atmosphere  into  a  state  unpropitious 
to  its  existence."4  The  epidemic  of  Marseilles,  in  1720,  ceased  on 
the  approach  of  winter.5  At  Erzeroum,  the  capital  of  Armenia,  the 
disease,  in  18-10,  broke  out  in  June,  and  in  1841,  in  August.  In 
both  instances,  it  was  put  a  stop  to  by  the  severe  cold  of  winter.6 
The  plague  epidemics  of  Constantinople  invariably  commence  in 
the  summer  season,  and  are  effectually  cut  short  by  frost.7  Yolney, 

1  Catcl,  8,  9;   Pym,  2,  8,  210;  Caillot,  106;  Dariste,  31. 

2  Humboldt,  4th  ed.  705. 

3  Hancock,  Laws  of  Contagion,  91 ;  Hodges,  Loitnologia,  5,  27. 

4  Vol.  i.  100,  ed.  of  Syd.  Soc.  5  Bertram.!,  Peste  de  Marseilles,  255. 

6  Report  of  Academy  of  Medicine,  81. 

7  Brayer,  Neuf  aris  a  Constantinople,   ii.  77  ;   Clot  Bey,   Traite  de  la  Peste,  225 ; 
Rapport  fait  u  1'Acad.  Roy.  de  Mod.  CoO. 


AUTUMNAL    FEVERS.  93 

who,  among  others,  has  noted  the  fact  of  the  cessation  of  the  disease 
on  the  accession  of  winter, 'says,  properly:  "The  winter  destroys 
the  plague  at  Constantinople,  because  the  cold  is  there  very  severe. 
The  summer  lights  it  up,  because  the  heat  is  damp."  In  Russia 
and  Poland,  the  same  result  has  been  noticed.  Tf  in  Egypt,  and 
other  hot  latitudes,  the  disease  usually  prevails  in  winter — com 
mencing  in  November  and  ceasing  in  June — it  is  because  that  season 
is  warm  and  damp.  But  even  there,  as  we  gather  from  no  less  an 
authority  than  Desgenettes,1  while  the  south  winds,  as  well  as 
hot  and  damp  air  favour,  if  they  do  not  occasion  its  development, 
the  north  winds,  and  the  extremes  of  cold  or  heat,  put  an  almost 
complete  stop  to  it.  Much  the  same  statements  are  made  by  Lar- 
rey,2  Clot  Bey,3  Assalini,4  and  Pugnet? 

Mr.  E.  Robertson,  who,  during  a  long  stay  in  Syria,  paid 
much  attention  to  the  subject  of  the  etiology  of  the  plague,  says 
that  the  disease  in  Turkey  and  Lowe/JEgypt  can  only  exist  in  a 
temperature  between  sixty  and  eighty 'degrees  (Fahr.),  "a  lower  or 
higher  either  modifying  or  utterly  destroying  that  atmospheric  con 
stitution,  or  those  other  occult  causes,  giving  rise  to  its  origin  and 
propagation."6  Nor  can  the  occasional  continuance  of  the  plague 
at  Aleppo,  as  we  learn  from  the  admirable  accounts  of  the  disease 
handed  down  to  us  by  Drs.  Alexander  and  Patrick  Russell,7  through 
the  Avinter,  after  the  accession  of  frost,  and  even  a  fall  of  snow,  be 
cited  as  militating  against  the  view  here  maintained.  Such  instances 
of  continuance  were  isolated  and  exceptional.  In  general,  the  dis 
ease  has  there  ceased  before  the  accession  of  winter — often  during 
the  months  of  August,  September,  and  October — having  begun  to 
decline  in  July ;  and  frequently  it  has  ceased  later  on  the  appearance 
of  cold.  In  those  instances,  as  in  1762,8  when  different  results  were 
obtained,  the  cases  were  few  in  number,  and  it  is  not  unreasonable 
to  attribute  them  partly  to  the  latency  of  the  poison  in  the  system 
of  persons  exposed  to  its  influence  previous  to  the  change  of  weather, 
and  partly  to  the  short  continuance  of  a  temperature  sufficiently 

1  Hist,  Med.  de  1'Armee  d'Orient,  248. 

2  Campagnes  d'Egypt,  330.  3  De  la  Peste,  Obscrvee  en  Orient,  2G6. 

4  Observations  on  the  Disease  called  the  Plague,  &c.  42. 

5  Mem.  sur  les  Fievres  de  Mauvais  Caractere,  £c.  204. 

6  Medical  Notes  on  Syria,  Edinburgh  Journal,  Ixii.  331. 

7  The  Natural  History  of  Aleppo,  2d  ed.  iv.     London,  1794;   A  Treatise  on  the 
Plague  of  Aleppo  in  1700,  17(51,  and  1702.     London.  1791. 

8  A  Treatise,  &c.  44. 


94  PNEUMONIA    AND 

low  to  destroy  completely  the  poison,  which  broke  out  anew  on  the 
accession  of  heat.1  It  is  true  that,  in  the  neighbouring  villages, 
caves,  and  grottoes,  the  disease  continued  some  time  in  winter,  after 
having  ceased  in  the  city ;  but  in  these  places  it  showed  itself  ex 
clusively  among  the  poorer  classes,  whose  habitations,  from  the 
mode  of  their  construction,  their  want  of  proper  ventilation,  the 
filthy  condition  in  which  they  were  kept,  and  the  great  heat  in 
which  their  inmates  indulged,  may  well  be  supposed  to  have  re 
tained  the  poison  in  sufficient  force,  if  not  to  have  been  hotbeds  of 
the  pestilence,  during  the  comparatively  moderate  and  short  winter 
of  that  country,  where,  according  to  Dr.  A.  Eussell,  the  thermometer, 
in  a  series  of  nine  years,  varied,  in  October,  from  51  to  84 ;  in  No 
vember,  44  to  65 ;  in  December,  40  to  55  ;  January,  from  34  to  57;  in 
February,  from  48  to  55  ;  in  ^rch,  from  44  to  67  ;  in  April,  from 
56  to  82 ;  while  in  May  it  mounted  up  frpp.  67  to  92.  To  this  it 
may  be  added  that,  in  most  purees  where  the  plague  has  prevailed 
during  the  winter  months,'as  in  Egypt,  at  Malta,  Toulon,  Aix, 
Venice,  Messina,  &c.,  that  season  is  not  characterized  by  severe  or 
long-continued  cold  weather,  arid  a  hard  bleak  frost  is  seldom  if 
ever  experienced. 

If,  nevertheless,  the  statement  of  the  purifying  agency  in  question 
is  still  denied — if,  while  acknowledging,  what  no  one  can  justifiably 
impugn,  the  truth  of  the  events  recorded,  it  is  maintained  that,  in 
the  association  of  the  accession  of  frost  with  the  cessation  of  fever, 
we  are  to  recognize  nothing  but  the  occurrence  of  a  fortuitous  coin 
cidence,  we  must  admit  that  the  frequency  of  that  coincidence,  and 
its  manifestation  in  so  many  and  diversified  places,  is  to  be  viewed 
as  a  matter  of  the  utmost  astonishment,  seeing  that  everywhere  the 
one  event  is  sure  to  follow  closely  on  the  heels  of  the  other. 

As  an  offset  to  this  it  has  been  remarked  that,  in  the  Havana, 
the  same  thing  happens  without  frost ;  and  that  hence,  when  the 
latter  occurs  in  any  place,  at  the  close  of  the  epidemic  season,  we 
have  no  right  to  affirm  that  it  produced  the  effect  assigned  to  it. 
This  cessation  of  fever  without  the  aid  of  frost  may  be  true.  In 
deed,  I  know  full  well  that  it  is  annually  observed  in  tropical 
climates — not  only  in  the  Havana  and  other  parts  of  Cuba,  but  in 
the  West  Indies  generally,  and  on  the  coast  of  tropical  America 
and  of  Africa.  Nor  could  it  be  otherwise.  There  frost  or  intense 

1  A  Treatise,  &c.  45. 


AUTUMNAL    FEVERS.  95 

cold  is  a  thing  never  heard  of,  and  yet  fever  epidemics  come  to  an 
end.     I  know,  also,  that  it  has  occasionally  occurred  in  some  parts 
of  Europe,  in  the  United  States,  and  even  in  this  very  city.    I  know 
full  well,  besides,  that  in  some  epidemic  visitations,  observed  in 
both  tropical  and  extra -tropical  regions,  the  disease  has  stopped,  not 
only  before  the  accession  of  frost,  or  cold  or  cool  weather,  but  even 
before  the  cessation  of  great  heat.     None  will  be  disposed  to  deny 
such  occurrences,   who   have   perused   attentively  the  history  of 
West  India  epidemics,  and  of  those  that  appeared  in  this  city  in 
1803,  in  Mobile  and  New  Orleans  in  1848,  as  described  by  Drs. 
Caldwell,  Nott,  and  Fenner,  and  in  Leghorn,  in  1801,  as  related  by 
Palloni.     But  these  facts,  true  as  they  doubtless  are,  do  not  in  the 
least  invalidate  the  reality  of  the  power  which  I  have,  in  common 
with  so  many  others,  ascribed  tdUeold  and  frost ;    for,  from  the 
circumstance  that  yello^ffever  has  sometimes  stopped  in  this  coun 
try,  and  usually  ceases  completely,  "SJia  great  measure,  in  tropical 
regions,  without  the  aid  of  frost,  and  sometimes  before  a  cessation 
of  high  atmospheric  heat,  we  cannot  argue  that  frost,  or  severe 
cold,  when  occurring  before  the^fever  has  been  arrested  in  its 
epidemic   course,  will   not   produce   that  effect.      This   cessation 
often  is  too  instantaneous,  and  is,  besides,  too  constantly  noticed, 
after  its  occurrence,  to  be  ascribed  to  any  other  agency.     The  two 
results  are  not  incompatible.     While,  therefore,  we  maintain  that 
the  effect  arises  most  usually  from  the  last-mentioned  cause,  we 
admit,  what  experience  has  sufficiently  demonstrated,  that  the  same 
beneficial  change  is  also  produced  through  other  agencies — heavy 
rains,  violent  storms,  heavy  winds,  especially  from  the  north,  desic 
cating  and  long-continued  heat  and  droughts,  and  not  unfrequently 
from  the  want  of  subjects  susceptible  to  the  morbific  impression  of 
the  poison ;  and  that,  at  times,  it  is  brought  about  by  a  change  in 
the  epidemic  meteor ation,  the  evolution  of  ozone  in  the  atmosphere, 
or  some  other  purifying  influence,  the  nature  of  which  has  so  far 
eluded  our  researches ;  a  change  which,  as  Dr.  Smith1  remarks,  is, 
in  effect,  equivalent  to  the  reduction  of  the  temperature  to  32°  of 
Fahrenheit.     The  same  effects  have  been  noticed  in  other  forms  of 
malarial  fevers;  and  every  one  is  familiar  with  the  fact  that,  in 
Egypt,  where,  for  reasons  mentioned,  the  plague  prevails  during 
the  winter  months,  it  stops  in  June,  under  the  empire  of  the  same 

1  On  Epidemics,  174. 


96  PNEUMONIA    AND 

parching  heat  which  in  that  country  arrests  the  progress  of  animal 
putrefaction.  But,  I  repeat,  were  these  occurrences  more  frequent 
than  we  know  them  really  to  be,  they  could  not  serve  to  counter 
balance  and  overthrow  all  that  has  been  said  in  support  of  the 
agency  ascribed  to  frost  and  severe  cold,  in  arresting  the  progress 
of  yellow  and  other  malarial  fevers. 

rent  are  the  results  obtained  in  regard  to  pneumonia. 

plain  enough  to  those  who  bear  in  mind  what  is  known 
of  the  causes,  habitat,  and  usual  periods  of  prevalence  of  that  dis 
ease,  the  occurrence  of  frost,  or  the  accession  of  cold  weather  has 
never  put  a  stop  to  it.  So  far  from  it,  while  such  a  favourable  change 
is  thus  experienced,  as  regards  the  prevalence  of  fevers  through 
the  means  in  question,  it^  ^und  that  pneumonic  inflammations, 
instead  of  disappearing  ii|^  the  former,  continue  to  show  them 
selves  as  though  nothing  jiad  occurred.  Indeed,  whatever  may 
be  the  tendency  tt*  the  disfeas^iik-any  locality — whether  the  num 
ber  of  cases  be  very  large  of  srnojjH,  and  whether  they  occur  in 
summer  or  autumn— the  attacks  multiply  on  the  accession  of  the 
very  influences  whiol^&d  put  a  stop  to  the  other  complaint ;  while, 
after  prevailing  during*- the  winter  and  spring,  and  taking  the  place, 
as  it  were,  during  those  seasons,  of  that  class  of  fevers  to  which 
attention  has  been  all  along  called,  their  reign  is,  in  its  turn,  more 
or  less  effectually  arrested  by  the  return  of  the  atmospheric  condi 
tions  under  the  empire  of  which  those  fevers  are  developed.  Let 
pneumonia  prevail  on  board  of  a  ship  in  some  warm  latitude — a 
thing  which  has  occasionally  occurred — and  it  may  be  doubted 
whether  the  commander  would  gain  much  by  steering  north  and 
reaching  the  banks  of  Newfoundland.  The  one  disease,  pneumonia, 
belongs  more  specially,  as  we  have  seen,  to  winter  and  early  spring, 
and,  if  not  arrested  completely,  is  at  least  greatly  diminished,  in 
point  of  frequency,  by  the  return  of  heat.  The  other  is  a  disease 
of  summer  and  autumn,  and  is  diminished  by  cool  weather  and 
arrested  by  frost.  Nothing  could  be  more  different.  It  affords  a 
strong  illustration  of  the  correctness  of  a  remark  long  ago  made  by 
Hippocrates,  that  the  diseases  of  winter  are  put  a  stop  to  by  sum 
mer,  and  those  of  summer  by  winter.  They  are,  to  a  certain  extent, 
antipodal  or  antagonistic.  At  any  rate,  the  occurrence  above 
stated — the  cessation  of  fever  through  the  instrumentality  of  frost, 

o  *j 

and  the  continuance  or  increase  of  pneumonia  after  the  accession  of 
the  latter,  cannot  be  regarded  otherwise  than  as  an  event  the  very 


AUTUMNAL    FEVERS.  97 

opposite  of  that  which  might  be  anticipated  were  the  diseases  off 
springs  of  one  and  the  same  cause,  and  were  the  latter,  pneumonia, 
really  and  substantially  nothing  more  than  a  peculiar  form  of  re 
mittent  and  intermittent  fever.  To  affirm  this,  in  the  face  of  the 
facts  just  mentioned,  it  will  be  necessary  to  put  the  syllogism  thus  : 
Autumnal  fevers  are  arrested  by  severe  cold  and  frost;  pneumonia 
is  unaffected  by  such  atmospheric  changes,  or  even 
rife  after  their  occurrence;  ergo,  autumnal  fevers  and 
are  identical,  or  the  latter  is  only  a  peculiar  form  oft  the  other. 
Again :  Fevers  appear  and  prevail  in  hot  weather ;  tfe  reign  of 
pneumonia  ceases  on  the  accession  of  such  weather ;  ergo,  the  two 
diseases  are  the  same ;  and  he  who  ventures  to  deny  their  identity, 
gives  proof  of  being  sadly  behind  thJLi^g.,  and  ought,  without  loss 
of  time,  to  imbue  himself  with  the -pphciples  of  the  Baconian 
philosophy.  „.  , 

Writers  who  uphold  the  opinion  luideH:  examination  will  not,  I 
trust,  strive  to  strengthen  the  ppsitibn  they  have  assumed,  by  in 
sisting  on  the  circumstance  that  as  pneumonia — which,  they  say, 
is  really  and  substantially  nothing  more  tM^.  *a  peculiar  form  of 
autumnal  fevers — continues  to  appear  after  the  accession  of  cold  and 
frost  has  put  a  stop  to  the  ordinary  forms  of  the  latter,  etiologists, 
who  maintain  that  the  cause  of  febrile  diseases  generally  is  destroyed 
by  a  reduction  of  temperature  below  the  freezing  point,  on  the 
ground  that  such  diseases  disappear  after  that  atmospherical  change, 
are  open  to  the  charge  of  hazarding  an  assumption  and  reaching 
a  conclusion  unwarranted  by  the  premises ;  inasmuch  as  all  that 
may  justly  be  deduced  from  the  phenomena  observed  is,  that  some 
forms  of  periodic  fever,  not  all,  are  arrested  by  the  advent  of  cold ; 
and  that  the  cause  has  been  merely  so  modified  as  to  cease  to  pro 
duce  a  certain  form  of  the  disease,  while  it  continues  to  possess  its 
original  power  of  occasioning  certain  other  forms.  The  force  of 
this  objection  few  will  feel  disposed  to  admit ;  for,  before  it  can  be 
used  with  success  in  the  settlement  of  the  question  at  issue,  it  would 
be  first  necessary  to  demonstrate  a  real  identity  or  close  alliance,  in 
a  pathological  or  symptomatological  point  of  view,  between  pure 
pneumonia  and  malarial  fevers.  But  this,  as  I  need  scarcely  remark, 
has  not  as  yet  been  and  never  can  be  done.  I  shall  have  occasion 
to  recur  to  the  subject  more  in  detail  hereafter. 

Of  necessity,  if  periodic  fevers  are  arrested  by  frost  and  cold, 
this  salutary  effect  is  due  to  the  destruction,  by  this  reduction  of 
7 


98  PNEUMONIA    AXD 

temperature,  of  the  cause  of  the  disease,  or  to  the  sudden  removal 
of  one  or  more  of  the  elements  which  enter  into  the  composition  of 
that  cause.  Of  the  nature  of  the  latter  I  can  entertain  no  doubt. 
In  common  with  many  a  clever  man,  from  time  immemorial  to  the 
present  day,  I  take  it  to  be  nothing  more  nor  less  than  malarious 
exhalations — poisonous  particles,  floating  in  the  atmosphere,  and 
arising  from  peculiar  changes  in  various  organic  substances  in  a 
state  of  decomposition.  But,  exclaim  some  of  the  advocates  of  the 
opinion  under  examination,  all  that  has  been  said  about  this  de 
struction  of  the  cause  of  febrile  affections — admitting,  for  the  sake 
of  argument,  that  these  do  cease  on  the  accession  of  frost — is  an 
assumption ;  for  we  cannot  show  that  a  thing  is  destroyed,  the  exist 
ence  of  which  has  not  been  proved.  Far  be  it  from  the  author  of 
this  volume  to  insist  on  the  possibility  of  frost  destroying  a  thing 
which  has  no  existence ;  jmcl  if  it  can  ever  be  proved  that  the  morbific 
cause  in  question  must  be  placed  in  that  category,  I  shall  certainly 
feel  no  disposition  to  say  anything  more  about  it.  But,  has  this 
been  done?  So  far  from  it,  we  look  in  vain,  in  what  has  been 
written  on  the  subject,  for  anything  calculated  to  disprove  the  ex 
istence  and  morbid  agency  of  malaria,  and  yet  this  ought  to  have 
been  well  established  before  it  could  justly  be  adduced  against  a 
belief  in  the  destructive  power  ascribed  to  frost,  and  the  mode  in 
which  it  is  stated  to  exercise  its  salutary  effects. 

For  my  part,  with  due  deference  to  the  judgment  and  learning 
of  those  who  entertain  an  adverse  opinion,  I  have  no  hesitation  in 
saying  that  the  more  I  examine  the  subject,  the  more  I  am  con 
vinced  that  those  who  ignore  the  existence  of  malarious  exhala 
tions,  and  deny  their  morbific  agency,  labour  under  a  great  error, 
and  contend  for  what  they  cannot  prove.  Nay,  more — I  am  con 
vinced  that  autumnal  and  endemic  fevers,  of  genuine  character,  are 
never  due  to  any  other  cause  than  such  exhalations.  Believing  this, 
and  holding,  at  the  same  time,  what  every  one  knows  to  be  true,  that 
pneumonic  inflammations  are  due  to  very  different  agencies,  it  may 
not  be  improper,  in  order  farther  to  show  the  fallacy  of  the  views  of 
those  who  insist  on  the  close  connection  between  those  diseases,  to 
dwell  on  some  of  the  leading  facts  and  arguments  on  which  a  belief 
in  the  existence  of  such  exhalations,  and  in  the  peculiar  and  specific 
effects  ascribed  to  them,  is  founded.  I  am  aware  that,  as  regards 
several  of  the  advocates  of  the  connection  mentioned,  the  task  is 
unnecessary,  inasmuch  as  they  admit  the  existence  and  morbid 


AUTUMNAL   FEVERS.  99 

agency  of  malaria ;  and  that,  while  regarding  periodic  or  autumnal 
fevers,  of  all  grades  and  types,  as  caused  by  the  latter,  they  do 
not  hesitate  to  recognize  in  pneumonia  a  similarity  of  origin ;  some 
applying  the  doctrine  to  all  manifestations  of  that  disease ;  others, 
perhaps  the  greater  number,  restricting  it  to  certain  cases,  charac 
terized  by  periodical  changes,  and  cured  by  remedies  found  success 
ful  in  intermittent  fevers.  By  others,  however,  a  different  opinion 
is  entertained  on  the  subject;  and  while  some  among  them  content 
themselves  with  remaining  in  doubt  as  to  the  propriety  of  admit 
ting  the  existence  of  a  specific  febrile  poison,  others  offer  a  decided 
and  uncompromising  opposition  to  the  malarial  origin  of  fever, 
holding  all  that  has  been  said  in  its  support  to  be  a  mere  effect  of 
a  disordered  imagination,  and  an  hypothesis  unworthy  of  this  age 
of  progress.  The  importance  of  the  subject  in  its  bearing  upon  the 
question  more  particularly  before  us,  will  be  my  excuse  for  enter 
ing  upon  the  examination  of  it  in  detail.  But  I  must  reserve  it 
for  a  separate  chapter. 


CHAPTER    II. 

y 

EXISTENCE  AND   MORBID   AGENCY   OF   MALARIA. 

IN  the  preceding  chapter,  attention  was  called  to  various  facts 
militating  against  the  opinion  entertained,  both  in  olden  and  mo 
dern  times,  by  some,  medical  writers,  respecting  a  supposed  close 
connection,  pathological  and  etiological,  between  pneumonia  and 
periodic  fevers.  In  the  prosecution  of  the  inquiry,  I  was  led  to  a 
consideration  of  some  circumstances'  connected  with  the  causation 
of  the  latter  diseases,  and,  in  so  doing,  touched  frequently  upon 
the  subject  of  malaria,  which  was  spoken  of  as  the  long  admitted 
efficient  agent  in  their  production.  Of  the  antiquity  of  this  opinion, 
and  of  its  very  general  adoption  at  the  present  day,  few  need  be  told. 

Hippocrates  was  of  the  opinion  that  diseases  in  general  may  be 
said  to  arise  either  from  the  food  we  eat,  or  the  air  we  breathe. 
When,  therefore,  a  disease  seized  on  a  multitude  of  persons  of  dif 
ferent  ages,  sexes,  and  habits,  he  inferred  that  it  must  arise  from  the 
latter  cause.  Animals,  he  says,  are  under  the  influence  of  the  air. 
Hence,  in  all  probability,  the  source  of  diseases  must  not  be 
sought  elsewhere  whenever  it  enters  the  body,  either  in  excess,  in 
deficient  quantity,  too  suddenly,  or  contaminated  with  morbific 
miasmata.  Of  epidemic  fevers,  the  cause  resides  in  the  air.  If, 
under  such  circumstances,  all  animals  are  not  affected  at  the  same 
time,  and  only  one  species  suffers  from  the  disease,  it  is  because  all 
things,  bodies,  natures,  aliments,  are  not  alike,  and  what  is  proper 
or  improper  for  one  species,  is  not  necessarily  equally  so  for  other 
species.  When,  therefore,  the  air  is  infected  with  miasms  that  are 
enemies  of  human  nature,  men  are  sick ;  when,  on  the  contrary,  the 
air  becomes  injurious  to  some  other  species  of  animals,  the  latter 
alone  is  affected.  (De  Flatilus,  sects.  5,  6.)  In  his  treatise  on 
Airs,  Waters,  and  Places,  he  attributes  the  greater  part  of  the  in 
jurious  effects  of  stagnant  streams,  and  marshy  situation,  to  drink 
ing  of  the  water  therein  found  (sects.  7,  8,  10,  15).  But  there  is 


102  PNEUMONIA    AND 

much  in  that  famous  treatise  which — especially  when  taken  in  con 
nection  with,  what  the  author  remarks  in  his  Discourse  on  Winds, 
just  quoted,  i.  e.  that  with  all  we  eat  or  drink,  air  finds  entrance 
into  the  body,  and  injures  it  when  tainted  with  miasma — leads  us  to 
infer  that,  in  his  opinion,  such  waters  do  not  affect  the  human  sys 
tem  injuriously,  simply  by  being  ingested,  but  sometimes  also  by 
the  miasma  contained  in  or  evolved  from  it.  But  whether,  by  the 
term  miasma,  he  understood  the  marsh  or  terrestrial  effluvia  of 
modern  times,  is  a  question  decided  in  the  negative  by  some,  and 
which  others,  as  Dr.  Adams,1  consider  as  impossible  to  be  determined. 
For  my  part,  I  am  inclined  to  believe — apart  from  the  references 
already  made — that  the  great  Greek  observer,  though  not  pointing 
out  distinctly  the  effects  pf  marsh  effluvia  in  engendering  the 
periodic  fevers  he  so  w^ll'  describes,  and  having  formed  no 
just  conception  of  their  nature  and  precise  sources,  recognized 
the  existence  of  miasma  as  $- separate  morbific  agent;  for  he  com 
mences  the  meteorological  year  from  the  decline  of  the  summer 
preceding  the  year  in  which  the  epidemic  he  is  about  to  describe 
occurs,  and  speaks  of  diseases  arising  from  a  certain  succession  of 
seasons.  Now,  as  a  determinate  series  of  intemperies  of  several 
seasons  cannot  produce  a  special  and  well-defined  effect  on  the  sys 
tem,  otherwise  than  through  the  medium  of  exhalations  of  some  sort 
from  the  earth,  which  are  by  them  occasioned,  we  cannot  greatly 
err  in  inferring  that  he  had  such  exhalations  in  his  mind  when  using 
the  term.  Hence  it  is,  Hippocrates  applies  to  the  cause  of  epidemics 
the  name  of  something  divine — an  expression  which  Galen,  in  his  com 
mentaries  on  the  epidemics,  regards  as  meaning  alterations  and  affec 
tions  of  the  air  arising  from  the  influence  of  the  stars.  Nor  is  it  less 
probable  he  included  under  that  same  name  an  invisible  fluid  float 
ing  in  the  atmosphere,  and  occasioning  in  it  the  alteration  and  affec 
tion  above  alluded  to ;  for  he  advocated  the  opinion  of  Pythagoras 
and  Heraclitus,  that  all  that  exists  under  a  sensible  form  arises  from 
invisible  corpuscles.  But,  however  this  may  be,  it  is  not  to  be  for 
gotten  that  neither  Hippocrates,  nor  his  contemporaries,  were  igno 
rant  of  the  fact  that  the  atmosphere  in  the  vicinity  of  marshes  and 
large  rivers  in  warm  climates  is  unwholesome  to  the  inhabitants  ;2 
that  in  his  aphorisms  he  refers  diseases  to  the  changes  of  seasons 
and  variations  of  temperature  occurring  during  these ;  and  that,  in 

1  Transl.  i.  3-19  ;  Syd.  Soc.  Ed.  2  Treatise  on  Regimen,  ii.  2. 


AUTUMNAL    FEVERS.  103 

the  third  book  of  his  Epidemics,  he  ascribes  the  fatal  or  pestilential 
disease  observed  by  him,  on  a  particular  occasion,  to  the  preter 
natural  and  unwholesome  state  of  the  atmosphere. 

Indeed,  that  a  knowledge  of  the  deleterious  effects  of  certain  con 
ditions  of  the  air  in  producing  fever  existed  among  the  contempo 
raries  or  immediate  successors  of  Hippocrates ;  that  they  knew  full 
well  that  such  an  unwholesome  air  was  the  result  of  something 
extraneous,  more  particularly  exhaling  from  marshy  surfaces ;  and 
that  they  were  fully  aware  of  the  advantage  and  necessity  of 
changing  the  physical  conditions'  of  these,  may  be  inferred  from 
many  of  the  allegorical  expressions  in  which  they  were  so  wont  to 
indulge,  as  well  as  from  some  passages  in  the  writings  of  ancient 
philosophers  and  historians.  In  accordance  with  the  custom  just 
alluded  to,  of  resorting  to  allegorical  expressions  to  convey  important 
truths  and  salutary  admonitions,  and  to  communicate  useful  know 
ledge,  the  ancient  Greeks  often  employed  the  words  monster,  serpent, 
venomous  beasts,  as  emblematic  of  marshes,  and  of  the  poisonous 
and  fatal  air  issuing  from  them.  It  is  in  this  sense,  doubtless,  as  was 
long  ago  surmised,  that  we  are  to  understand  the  fictions  concerning 
the  hydra,  the  chersydra,  and  the  monster  python,  slain  by  Apollo; 
derived,  as  those  words  are,  the  one  from  the  Greek  root,  meaning 
putrefaction  or  corruption ;  the  others  from  the  word  water.  Thus 
it  is  they  personified  the  many -headed  hydra  under  the  emblem 
of  a  huge  water-snake,  whose  poisonous  breath  infected  the  air,  and 
imparted  disease  to  animals  that  breathed  it.  Nor  are  we  less  jus 
tified  in  inferring  that  the  terms  hydra  and  chersydra  were  allego- 
rically  employed  to  designate  the  two  and  opposite  conditions  of 
marshes — the  one,  in  which  these  are  covered  with  water,  the  other 
in  which  they  are  left  bare — hydra  representing  the  snake  con 
cealed  in  the  bosom  of  the  stagnant  and  miry  fluid,  and  chersydra 
meaning  the  desiccation,  in  hot  seasons  and  regions,  of  those  locali 
ties,  when  they  give  issue  to  an  air  more  virulent  and  poisonous 
than  that  connected  with  their  overflow.  Every  one  recollects  the 
story  of  Hydra,  the  celebrated  monster  which  infested  the  neigh 
borhood  of  the  lake  of  Lerna,  in  the  Peloponnesus,  with  its  number 
less  heads — one  hundred,  according  to  Diodorus  Siculus;  fifty,  agree 
ably  to  Simonides ;  and  nine,  if  we  may  credit  Apollodorus — and 
presenting  this  remarkable  peculiarity,  that  the  central  head  was 
immortal;  and,  as  regards  the  others,  as  one  was  cut  off',  two  imme 
diately  grew  up,  if  the  wound  was  not  cauterized  by  fire.  It  was  one 
of  the  labours  of  Hercules  to  destroy  this  dreadful  monster ;  an  ope- 


10-i  PNEUMONIA    AND 

ration  he  easily  effected  with  the  assistance  of  lolaus,  who  applied 
burning  iron  to  the  wound  as  soon  as  each  head  was  cut  off.  The 
allegory  appears  so  plain  as  to  induce  many  modern  writers  to 
adopt  the  views  above  expressed,  and  to  consider  this  fable  as  a 
symbolical  representation  of  the  clearing  and  draining  of  the  Pelo 
ponnesus  by  the  first  authors  of  civilization.  It  was  so  regarded  by 
some  of  the  ancient  writers  themselves;  for  Antipater,  the  stoic, 
speaks  of  the  "exhalations  from  the  damp  or  wet  earth  rising  up 
like  a  winding  stream  with  a  Vurning  force,  and,  after  having  been 
heated,  darting  down  again  in  the  way  of  a  deadly  serpent,  poi 
soning  and  infecting  everything  by  means  of  its  corrupting  agency." 
"Not  without  reason,"  he  adds,  "did  Heraclitus  give  the  name  of 
arrow  of  Apollo  to  the  rays  of  the  sun,  for  they  beget  corruption 
in  the  dampness  of  the  soil.  Hercules,  the  greatest  subduer  of  the 
foggy  atmosphere  in  times*  pastf  was  placed  among  the  gods,  for 
having  destroyed  the  hydra;  in  other  words,  for  having  reclaimed 
the  marshy  desert." 

Such  being  the  case,  we  may  infer  that  the  early  Greeks,  though 
doubtless  far  from  possessing  correct  notions  as  to  the  nature  of 
malaria,  as  understood  at  the  present  day,  or  having  an  insight  into 
its  laws,  were  perfectly  conversant  with  the  deleterious  effects  of 
marshy  surfaces;  and  awrare,  also,  that  the  diseases  incidental  to 
such  localities,  are  due  not  to  changes  in  the  sensible  qualities  of 
the  atmosphere,  but  to  a  peculiar  condition  of  the  latter  arising  from 
the  admixture  of  a  poisonous  element  issuing  from  the  stagnant 
water  of  marshes,  and  rendered  still  more  baneful  by  the  partial 
desiccation  of  the  miry  surface.  The  history  of  Empedocles,  and 
more  particularly  of  the  means  he  employed  to  arrest  the  pestilence 
by  which  the  city  of  Selinonte  was  ravaged,  to  which  I  shall  have 
occasion  to  revert  in  a  future  chapter,  would  seem  to  prove,  beyond 
doubt,  that  he  at  least  was  fully  aware  of  the  agency  of  noxious  ex 
halations  in  the  production  of  febrile  diseases. 

At  a  period  less  remote  from  our  own,  the  Romans,  without  hav 
ing  a  very  clear  idea  of  the  manner  in  which  malaria  is  pro 
duced,  expressed  opinions  and  offered  explanations  of  facts,  which 
would  do  no  discredit  to  modern  etiologists ;  for  though  differ 
ing  as  to  what  the  tiling  exactly  was  which  exhaled  from  marshes 
(considered  as  a  philosophical  rather  than  practical  question),  con 
taminated  the  atmosphere,  and  caused  sickness,  and  though  indulging 
in  a  variety  of  whimsical  opinions  on  the  subject,  enough  is  found 
in  their  writings  to  show  that  they  had  recognized  the  unhealthiness 


AUTUMNAL    FEVERS.  105 

of  marshes  and  marshy  surfaces,  and  ascribed  the  effect  to  some 
thing  beyond  modifications  in  the  sensible  qualities  of  the  atmo 
sphere.  Lucretius,  who,  though  only  a  poet,  may  reasonably  be 
supposed  to  have  reflected,  in  his  Rerum  Natures,  the  scientific 
views  of  the  professional  men  of  his  time,  observes  (vers.  1,100),  that 
the  cause  of  epidemic  and  pestilential  diseases  may  be  referred  to 
one  or  other  of  two  sources :  first,  to  the  atmosphere,  through  the 
agency  of  germs  wafted  to  the  sickly  place  by  the  winds,  in  the 
same  way  that  these  impel  clouds  from  place  to  place ;  or,  secondly, 
to  the  earth  itself,  when  the  latter,  through  means  of  long-continued 
rains  and  strong  atmospheric  intemperies,  covered  over  with  water 
and  heated  by  the  rays  of  the  sun,  undergoes,  together  with  the 
remains  of  organic  substances  spread  >t>ver  its  surface,  the  putre 
factive  process,  and  thereby  gives  vent  to  miasms  and  germs  analo 
gous  to  those  before  mentioned  a§  wafted  from  other  places.  Virgil 
sings  of  the  emptiness  of  the  city  of  Acerrse,  whose  population 
had  been  thinned  by  the  sluggish  course  of  the  Eiver  Clanius — et 
vacuis  Clanius  non  cequus  Acerris.  Varro  ascribed  the  mischief  to 
swarms  of  insects.  "It  is  worthy  of  remark  in  marshy  places,"  he 
says,  "that,  as  they  dry  up,  there  are  produced  certain  very  small 
insects,  too  minute  for  observation  by  the  eye ;  which,  being  taken 
into  the  body  by  the  mouth  and  nostrils,  are  the  cause  of  difficult 
diseases."1 

Columella  writes  that  "a  marsh  ought  not  to  be  in  the  neigh 
bourhood  of  buildings,  nor  military  way,  because,  when  acted  upon 
by  heat,  it  ejects  a  baleful  poison,  and  engenders  animals  armed  with 
troublesome  stings,  which  settle  upon  us  in  the  thickest  swarms. 
Then,  too,  it  emits  the  venomous  hosts  of  water-snakes  and  ser 
pents,  freed  from  their  winter's  slime,  mud,  and  fermentative  col- 
luvies ;  and  from  these  there  arise  frequently  obscure  diseases, 
whose  causes  have  not  been  investigated,  even  by  physicians.''2 
When  we  come  to  inquire  what  these  obscure  diseases  were,  we. 
find  that  they  consisted  of  the  several  varieties  of  autumnal  fevers. 

Palladius  is  of  opinion  that  "a  marsh  is  to  be  avoided  upon  every 
principle,  especially  on  the  south  or  west,  or  if  it  usually  dries  up 
in  summer,  because  it  generates  pestilence  and  hostile  animals."3 
Vitruvius  says  that  "the  vicinity  of  marshes  ought  to  be  shunned, 
because  when  the  morning  breezes  reach  the  house,  with  the  rising 

1  De  Re  Rustica,  lib.  i.  cap.  12.  2  De  Ee  Rustica,  lib.  i.  cap.  5. 

3  De  Re  Rustica,  lib.  i.  tit.  7. 


106  PNEUMONIA    AND 

sun,  they  bring  with  them  mists  and  exhalations  tainted  with  the 
poison  of  the  marshy  brood.  And  this  mixture  of  venom  with 
fog  is  conveyed  by  the  winds  to  the  bodies  of  the  inhabitants,  and 
renders  the  place  pestilential."1 

Diodorus  Siculus  (xiv.)  states  that,  at  the  siege  of  Syracuse,  the 
Carthaginians,  being  encamped  in  the  immediate  vicinity  of  an 
infectious  marsh,  and  exposed  to  the  thick  and  heavy  vapours  issuing 
therefrom,  and  being  moreover  accumulated  on  a  low  and  humid 
locality,  a  pestilential  fever  broke  out  among  them,  and  gave  rise 
to  a  large  mortality.  To  the  same  cause  he  attributes  the  plague 
of  Athens  (xii.  58).  Galen  attributes  the  origin  of  epidemics  to 
the  state  of  the  atmosphere,  at  least  in  a  great  measure,  but  he  also  • 
maintains  that  the  nature  of  the  country  may  contribute  to  the  same 
effect;  as,  for  example,  its  vicinity  to  a  gulf  like  the  Charonean,  from 
which  miasmata  are  exhalec^  I^rom  these  the  air  is  tainted,  and 
diseases  are  produced.  Tntis,  in  many  passages  of  his  Commentaries 
on  the  Epidemics  of  Hippocrates,  he  Abates  that  such  diseases  are  to  be 
referred  to  the  first  of  these  causes — the  condition  of  the  country  in 
which  they  prevail;  and  in  another  work,  he  openly  and  explicitly 
states  that,  for  the  most  part,  they  are  derived  from  the  atmosphere 
being  tainted  with  putrid  exhalations.  He  ascribed  a  large  share 
of  agency  in  the  production  of  the  impurity  of  the  air  to  intense 
heat  and  the  decomposition' of  organic  substances,  observing  that 
the  putrefaction  of  dead  bodies  left  unburnt  on  a  field  of  battle,  in 
hot  weather,  is  a  fruitful  cause  of  pestilence,  under  which  name 
wide-spreading  fevers  of  various  grades  were  then  included,  and 
adds  that,  in  other  cases,  the  impurity  is  occasioned  by  the  exha 
lations  of  certain  marshes  or  lakes  in  the  summer  season.2 

Judging  from  the  little  he  says  of  epidemics,  Celsus  may  be 
regarded  as  having  entertained  opinions  similar  to  those  of  Hip 
pocrates.3 

Not  very  different  is  the  opinion  of  Paulus  ./Egineta :  "  The 
nature  of  the  country  will  also  often  occasion  common  diseases, 
either  from  its  lying  adjacent  to  marshes,  or  to  some  deep  pit  which 
emits  a  deleterious  and  pernicious  exhalation."4 

According  to  Hally  Abbas  (Theor.  v.  2),  the  principal  causes  of  a 
pestilential  state  of  the  atmosphere  are,  the  nature  of  the  country 

1  Arclut.  lib.  i.  cap.  iv.  2  De  Febribus  Diff.  lib.  i.  cap.  4. 

3  De  Re  Medicina,  i.  47  ;  Paris  edit. 

4  The  Seven  Books  of  Paulus  ^Egineta ;   Adams's  transl.  i.  273. 


AUTUMNAL    FEVERS.  107 

and  the  season  of  the  year.  The  former  cause  produces  its  effects 
through  means  of  the  effluvia  arising  from  corrupted  fruits,  pot 
herbs,  &c.,  or  the  miasmata  from  marshes,  cloacas  or  dead  bodies, 
whether  of  men  or  cattle.  Avicenna  (iv.  1,  4)  differed  little  from 
Galen,  attributing  fevers  to  a  humid  and  warm  state  of  the  atmo 
sphere,  the  stagnant  air  of  caverns,  the  miasmata  of  lakes  and 
marshes,  and  the  effluvia  from  dead  bodies.  Avenzoar  also 
attributes  epidemic  diseases  to  a  humid  and  warm  state  of  the 
atmosphere,  effluvia  from  dead  bodies,  stagnant  air,  the  miasmata 
from  stagnant  and  corrupted  waters,  and  unwholesome  food  (iii. 
1,  3).' 

The  summer  and  autumnal  fevers  of  Kome  and  the  adjoining 
territory  attracted  the  notice  of  and  are.  often  alluded  to  by  Livy, 
Strabo,  Dionysius,  Dio  Cassius,  and  others ;  and  sufficient  was  said 
on  the  subject  to  show  that  already  at  ^very  early  period  the  cause, 
though  not  thoroughly  understood,  was  not  viewed  as  similar  to 
those  giving  rise  to  ordinary  di^ases,  but  very  generally  ascribed 
to  an  impure  state  of  the  atmosphere,  the  effect  often  of  the  over 
flow  of  the  Tiber,  and  of  other  kindred  occurrences.  The  opinion 
of  the  production  of  fevers  through  the  agency  of  exhalations  gave 
way  to  the  fantasies  of  the  Middle  Ages — occult  causes,  conjunction 
of  the  planets,  &c.  "Whatever  was  left  of  it  was  almost  completely 
absorbed  or  chased  away  by  the  doctrine  of  the  contagium,  which, 
in  the  hands  of  its  talented  originator,  Fracastorius,  and  of  his  many 
followers,  was  made  to  explain  almost  every  epidemic  disease. 
Though  at  all  times  experiencing  opposition  from  writers,  who,  like 
Montanus  and  Yaleriola,  adhered  more  or  less  strictly  to  the  views 
of  their  ancient  masters,  the  doctrine  of  contagion  may  be  said  to 
have  remained  in  the  ascendant  till  the  days  of  Fernelius,2  to  whom 
credit  is  due  for  having  been  the  first,  after  the  renewal  of  letters, 
to  show  the  influence  of  contaminated  air  in  the  production  of  epi 
demics,  and,  as  M.  Eochoux  has  well  remarked  (p.  125),  laid  down 
the  doctrine  of  miasmatic  infection  in  a  way  which  leaves  scarcely 
anything  to  desire.  Niccola  Massa,  Alphani,  Porteus,  Pare,  Pisa- 
nelli,  advocated  opinions  relative  to  the  causes  of  autumnal  fevers 
not  very  different  from  those  generally  entertained  at  the  present 
day. 

Indeed,  almost  all  the  Galenics,  down  to  Sennertus,  comprehended 

1  See  Adams's  Commentaries  on  Paulus  ^Egineta,  i.  276,  &c. 

2  Universa  Medicina,  &c.,  De  abditis  rerurn  causis,  lib.  ii.  497,  1552. 


108  PNEUMONIA    AND 

the  universal  noxiousness  of  muddy  and  swampy  places,  under  the 
naked  words  evaporation,  exhalation,  and  emanation,  and  ascribed 
it  to  certain  poisonous  qualities  of  the  air.  Fracastorius  him 
self  states  that,  in  1528,  a  pestilential  fever  prevailed  extensively  in 
Italy,  and  was  caused  by  an  extraordinary  overflow  of  the  Po,  and 
consequent  formation  of  numerous  marshes.1  Prosper  Alpinus,  who 
practised  in  Egypt  from  1580  to  1584,  ascribed  the  plague  of  that 
country  to  morbid  exhalations.  In  reference  to  the  pestilential 
fever  of  Alexandria,  he  remarks  .that  opinions  varied  as  to  its  cause. 
By  some  it  was  attributed  to.  putrid  exhalations  arising  from  the 
lake  of  Mareotis,  and  conveyed  to  the  city  by  the  winds.  Other 
physicians  referred  them  to  putrid  and  poisonous  exhalations  min 
gling  with  the  ajr,  and  arising  from  putrid  and  bad  water  contained 
in  reservoirs  under  the  city,  which  were  filled  during  the  overflow 
ing  of  the  Nile,  in  order  ''to  afford  a  supply  to  the  inhabitants 
throughout  the  year.2  The  agency  of  marshes,  pools,  pits  for  mace 
rating  hemp,  unburied  bodies  of  men  and  animals,  and  similar 
sources  of  contamination  of  th^r atmosphere,  "  are  familiarly  men 
tioned  by  a  writer  who  calls  himself  Troiio  Lancetta,  and  who 
published  at  Venice,  on  the  16th  of  June,  1632,  a  short  treatise  on 
a  pestilence  then  prevailing  at  Venice,  and  on  the  means  of  arrest 
ing  its  progress."3  Eamazzini  pointed  out  very  accurately  the 
causes  of  the  epidemic  fevers  which  for  several  years  prevailed  in 
and  about  Modena  toward  the  close  of  the  seventeenth  century, 
attributing  them  to  the  action  of  an  atmosphere  tainted  with  many 
acid  and  earthy  exhalations  rising  from  a  muddy,  and,  as  it  were,  a 
fermented  soil.4  Bontius,  who  practised  for  several  years  at  Batavia, 
prior  to  1631,  describing  the  state  of  the  air,  says:  "It  is  rendered 
insalubrious,  not  only  from  its  heat  and  moisture — the  promoters  of 
putridity — but  also  by  the  stagnant  and  marshy  places  with  which 
the  country  abounds ;  and  the  wind,  blowing  from  the  mountains, 
bring  to  the  city  from  these  marshes,  dense,  fetid,  and  poisonous 
exhalations,  which  corrupt  the  air."5  Sylvius  (De  le  Boe)  traced  an 
epidemic  which  broke  out  at  Leyden  in  his  time  to  the  stagnant 

1  De  Morbis  Contagiosis,  lib.  ii.  cap.  vii.  in  Opera  Omnia,  100. 

2  De  Medicina  ^Egyptiorum,  lib.  i.  cap.  14;  25—6.     Paris,  1G45. 

3  Ed.  Med.  J.  Ixxviii.  231. 

4  De  constitutione  anni  1690,  de  Epidemia  quoe  Mimitensis  agris  ct  Yicinarum  rc- 
gionem,  &c.  Modena,  1691,  4to. 

5  De  Medicina  Indorum,  Dialogus,  i.  13. 


AUTUMNAL    FEVEKS.  109 

and  corrupted  waters  from  which  exhaled  noxious  vapours,  which 
remain  in  the  lower  part  of  the  atmosphere.1  Hoffman,  when  treat 
ing  of  the  evil  results  of  a  moist  atmosphere,  says :  "  The  cause  of 
all  these  accidents  is  justly  and  properly  traced  to  the  atmosphere, 
rendered  sluggish,  heavy,  and  destitute  of  elasticity,  by  marsh 
effluvia." 

Baglivi,  whose  work  on  the  practice  of  physic  was  written  about 
the  close  of  the  seventeenth  century,  remarks  on  this  subject :  "  The 
Eoman  air  is  likewise  foul  and  unwholesome — not  in  all  places, 
indeed,  but  those  chiefly  where  houses  are  wanting,  and  the  air  is 
slow  and  unmoved ;  and,  above  all,,  in  such  places  as  lie  upon  the 
Tiber,  or,  like  valleys,  are  hedged Jn  by  mountains,  or  are  exposed 
to  the  exhalations  that  rise  from  old  ruinous  walls*  vaults,  and  the 
rubbish  of  the  ancient  edifices.  Hence,  il  is  manifest  that  the  quar 
ter  of  the  Circus  Maximus,  lying  between  the  Palatine  and  Aventine, 
the  Tiber  and  Ostiaii  Gate,  is  very  unwholesome  and  pernicious."2 

About  the  same  period,  Chirac,  5n'  describing  the  epidemic  of 
malignant  or  yellow  fever  which, prevailed  at  Eochefort  in  1694. 
and  was  then  designated  under  tlie  name  of  plague,  says  of  that 
place,  that  it  is  situated  on  the  Eiver  Charente,  and  is  sheltered 
from  the  north  wind  by  a  high  hill  and  the  remains  of  a  thick 
wood.  On  the  east  side  is  situated  a  large  meadow,  which  is  almost 
annually  overflowed  by  the  river,  and  thereby  converted  into 
marshes  filled  with  muddy  and  stinking  water.  These  marshes  dry 
up  during  the  summer,  and  impart  to  the  air  of  the  port  a  smell  of 
burnt  powder,  especially  towards  evening,  when  the  dew  begins  to 
fall.  To  these  exhalations — which  he  regards  as  always  extremely 
dangerous — Chirac  attributed  the  fever  in  question.  This  inference 
he  considered  natural,  because  he  had  before  his  eyes  the  results  of 
observations  made  annually  in  all  paludal  countries,  "  whose  inha 
bitants  are  scourged  by  malignant  fevers,  which  there  break  out, 
almost  every  summer,  when  the  marshes  are  dried  up,  and  the  air 
becomes  surcharged  with  the  indigestible  and  offensive  sulphurs 
which  exhale  from  the  mud.3  By  Porzio  and  others  attention  was 
called,  about  the  same  time  or  not  long  after,  to  the  Hungarian 
fever.  Finally,  Lancisi,  collecting  all  the  facts  and  information 
already  possessed,  and  adding  many  he  himself  had  amassed  during 

1  Oratio  dc  affectus  epidemic!  Leidensis  causis  naturalibus  dicta,  1670.  12mo. 

2  Opera  Omnia  :  Venitiis,  1754,  81. 

3  Traite  des  Fievres  Maligues,  &c.  i.  31,  141,  147. 


110  PNEUMONIA    AND 

a  period  of  observation  of  thirty  years,  made  them  illustrate  the 
etiology  of  epidemic  and  endemic  diseases  in  general,  which  he 
ascribes,  as  every  one  knows,  to  marsh  and  other  exhalations.1 

From  that  day  to  the  present,  the  existence  of  a  poisonous  mat 
ter  floating  in  the  atmosphere  of  febriferous  localities,  and  its  spe 
cial  agency  in  the  production  of  autumnal  fevers,  have  been  admit 
ted  by  professional  men  of  all  countries.  The  sources  whence  it  is 
derived,  the  atmospheric  conditions  which  favour,  retard,  or  prevent 
its  development,  and  the  laws  by  which  it  is  governed,  have  been  in 
vestigated;  its  geographical  tfffei  altitudinal  limits  have  been  traced ; 
the  baneful  influence  it  exercises*  the  various  characters  it  assumes — 
as  shown  by  the  diversified  forms  of  fever  it  produces — the  modifi 
cations  it  imparts  to  other  complaints,  and  the  particular  mode  of 
treatment  it  renders  necessary,  have  been  pointed  out  in  many 
didactic  works,  and  in  more  numerous  publications  of  less  pre 
tension. 

t- 

The  agency  of  malaria  not  universally  admitted. — It  is  scarcely 
necessary  to  remark,  that  however  evidently  well  founded  the  in 
ference  respecting  this  agency  has  appeared  to  professional  ob 
servers  in  all  parts  of  the  world;  however  universally,  indeed,  the 
doctrine  which  ascribes  autumnal  or  periodic  fevers,  of  all  grades 
and  types,  to  the  morbific  influence  of  malarial  exhalations,  has 
been  recognized,  during  along  succession  of  years,  as  placed  beyond 
the  possibility  of  doubt  or  disputation,  its  advocates  have  not  been 
left  in  undisturbed  possession  of  the  field.  Doubts  as  to  its  correct 
ness  have  been  expressed ;  objections  have  been  raised ;  and,  by 
more  than  one  writer,  the  very  existence  of  malaria,  or  its  agency 
in  the  production  of  autumnal  fever,  has  been  denied.  And  why 
should  it  be  otherwise?  The  reader  must  be  aware  that  it  would 
be  difficult  to  discover  an  admitted  fact  in  practice,  or  a  correct  or 
plausible  point  in  theory,  whether  on  pathology  or  etiology,  which 
has  not,  at  some  time,  or  in  some  place,  encountered  greater  or  less 
opposition,  or  whose  correctness  has  not  been  flatly  denied.  Who 
does  not  know  that  the  doctrine  of  the  circulation  met  for  years 
with  the  most  strenuous  opposition,  and  could  not  obtain  a  footing 
in  some  of  the  most  renowned  schools  of  Europe  ?  The  remedial 
effects  of  antimony,  of  mercury,  of  the  lancet,  and  other  therapeutic 

1  De  Noxiis  Paludum  Effluviis.  Dissertatio  de  Nativis,  deque  adventitiis  Roman! 
coeli  qualitatibus,  16. 


AUTUMNAL    FEVERS.  Ill 

agents,  have  been  violently  opposed,  and  given  rise  to  wars  which, 
though  less  imaginary,  appear  almost  as  ludicrous  to  us  as  those 
which,  as  we  are  told,  raged  between  the  big  endians  and  the  little 
endians.  The  specificity  of  morbid  action  has  been  scoffed  at,  and 
the  hypothesis'  of  the  unity  of  all  diseases  extolled,  even  by  the 
clearest  intellects.  The  utility,  first  of  inoculation,  and  next  of  vac 
cination,  has  encountered  more  t]ian  one  virulent  opponent,  and  the 
danger  of  the  latter  process  has  been  insisted  upon  in  volumes  of 
large  dimensions.  Professional  men  are  found  in  this  nineteenth  cen 
tury,  who,  discarding  the  results  of  the^&ccumulated  experience  of  a 
hundred  successive  generations,  embrace  the  absurdities  of  homoeop 
athy,  and  seriously  believe  in  the  wonderful  effects  of  a  decillionth 
part  of  a  grain  of  si-lex  or  charcoal.  Hydropathy  enumerates  warm 
partisans  among  physicians  in  Europe  and  this  country;  and  surely, 
if  such  has  been  and  continues  to  be  the  case  in  relation  to  the  seve 
ral  subjects  mentioned,  We  cannot  be  surprised  at  finding  the  ques 
tion  of  the  existence  or  morbid  agency*  of  malaria  sharing  the  same 
fate.  Hence,  in  Italy,  Giannini,1  Folchi,2  Santarelli,3  and  Mienzi,4 
have  exerted  themselves  to  controvert  the  long-received  views  on 
the  subject.  In  France,  the  same  opposition  has  been  made  by 
Lafont-Gouzy,5  Eamel,6  and  Keveille'  Parise.7 

In  England,  Armstrong,8  Hopkins,9  Calvert,  Pritchett,10  Sir 
James  Murray,11  and  Dundas,12  have  inscribed  themselves  among  the 
opponents  of  malaria.  In  this  country,  too,  the  existence  of  this 
agent  has  been  denied  by  Kumph,13  Strobbart,14  Jones,15  Lee,16  Gay- 

1  Delia  Natura  della  febbri,  cap.  2,  vol.  i.  110,  2d  ed. ;  French  translation  of  d. 
i.  220. 

2  Sull'  Origine  delle  Intermittent!  di  Roma  e  sua  Campania.     Roma,  1828.     See 
N.  A.  J.  v.  for  a  translation  of  this  Essay. 

3  Ricerche  Interno  alia  causa  delle  Febbre  Perniciosa  dominento  nello  Stato  Ro 
mano,  32.  4  Sopra  cegenesi  delle  febbri  Interm.     Roma,  1844. 

5  Caracteres  Propres,  Pre"servatifs  et  Remedes  des  Contagions,  1822.     See  Monfal- 
con,  47,  note. 

6  De  PInfluence  des  Marais  et  des  Etangs  sur  le  Sante  des  Hommes.     Paris,  1802. 
Monfalcon,  527. 

7  Journal  General  de  Medecine,  xcvii.  105. 

8  The  Influence  of  Climate  on  the  Human  Constitution,  33. 

9  London  and  Edinb.  Philos.  Magazine,  3d  series,  No.  86. 

10  Some  Account  of  the  African  Remittent  Fever,  109. 

11  Dublin  Medical  Press,  Nov.  27,  1844.  I2  Sketches  of  Brazil,  154. 

13  Some  Thoughts  on  Malaria,  and  Doubts  as  to  its  Existence  as  a  Source  of  Disease. 
Charleston  J.  iii.  37.  14  Thoughts  on  Malaria.  Charleston  J.  vi.  661. 

15  Boston  J.  ii.  376.  1G  Forry,  Climates  of  the  U.  S.  109. 


112  PNEUMONIA    AND 

ley,1  Bell,2  Merrill,3  and  a  few  others ;  while  everywhere  writers 
are  encountered,  who,  though  not  openly  striving  to  disprove  the 
special  agency  of  morbid  exhalations,  say  nothing  about  them,  and 
content  themselves  with  looking  to  other  causes  to  account  for  the 
occurrence  of  fever. 

Objections  made  to  the  agency  of  malaria,  various. — But  while 
all  these  various  writers  unite  in  rejecting  or  ignoring  the  exist 
ence  of  malaria,  they  differ  widely  as  regards  the  substitute  they 
propose.  The  one  refers  all  the  mischief  to  the  action  of  heat 
on  the  system.  A  second  considers  atmospheric  or  terrestrial 
humidity  as  the  efficient  agent.  A  third  explains  all  the  pheno 
mena  by  means  of  atmospheric  vicissitudes — heat  by  day,  cold  by 
night.  Then  again,  we  are  told  that  the  true  cause  of  periodic  fevers 
must  be  sought  in  a  lowK4ej-point;  or  in  the  action  of  fogs  or  of 
visible  dews,  "  the  phenori^|pp|)f  which  are,  in  fact,  all  the  pretended 
laws  of  miasma ;"  or  in  tfe&  ^fpnence  or  deficiency  of  atmospheric 
electricity,  or  in  the  presence  of  some  particular  and  well-known 
gas.  There  are  not  even  wanting  those  who  think  that  unnutri- 
tious  food  exercises  a  more  powerful  agency  in  the  production  of 
periodic  fever  than  any  other  cause.  On  all  these  several  and  diver 
sified  hypotheses  much  has  been  written.  Facts,  and,  when  possible, 
experiments  have  been  appealed  to;  learning  and  ingenuity  have 
often  been  displayed ;  but  from  all  I  have  read  and  seen  on  the 
subject,  I  am  inclined  to  the  opinion  that  the  opponents  of  malaria 
have  left  the  question  precisely  where  they  found  it,  and  that,  so  far 
from  adducing  anything  calculated  to  disprove  the  existence  of  that 
poison,  or  establishing  the  correctness  of  their  own  views,  they  have 
done  much  to  involve  the  whole  subject  in  inextricable  confusion, 
by  constantly  confounding  the  predisposing  and  exciting  influence 
with  the  efficient  cause  of  those  diseases,  and  raising  the  former  to 
the  dignity  of  the  latter.  Convinced  of  this,  and  of  the  existence 
of  malaria  as  a  distinct  morbific  agent ;  regarding  it  as  the  special 
cause  of  autumnal  fevers,  and  as  completely  independent  of  and 
distinct  from  those  influences  which  give  rise  to  pneumonic  inflam- 

1  Am.  Med.  J.  N.  S.  xvii.  53. 

2  On  Miasm  as  an  alleged  Cause  of  Fever.     Philad.  J.  of  Medical  and  Physical  Sc. 
ii.  N.  S.  274. 

3  Address  to  the  Memphis  Med.  Soc.  on  the  Sanitary  Condition  of  that  City.     Mem 
phis  Med.  Recorder,  i.  99. 


AUTUMNAL    FEVERS.  113 

mation,  and,  as  a  consequence,  being  persuaded  that  the  reality  of 
this  agency,  if  satisfactorily  established,  must  lend  a  powerful  aid 
in  the  refutation  of  the  views  under  examination,  I  propose  in  the 
present  chapter,  and  before  proceeding  farther  in  the  matter  under 
consideration,  to  examine  somewhat  in  detail  the  leading  facts  and 
arguments  on  which  the  malarial  doctrine  rests,  and  to  note  a  few 
of  the  objections  that  have  been  raised  against  it. 

The  appearance  of  fever  where  tJiere  are  no  marshes  does  not  disprove 
the  agency  of  malaria. — By  those  who  reject  this  doctrine,  it  is  not 
unfrequently  urged  in  a  tone  of  confident  triumph  that  its  advocates 
ascribe  to  rnarsh  miasma  those  very  fevers  which  we  meet  with  in 
their  most  malignant  forms  in  situations  where  there  are  no  marshes 
existing;  arid  that  this  is  pertinaciously  followed  up,  although  con 
tradicted  by  every  day's  experiejace.^,  Hence,  they  add,  if  fevers 
arise  without  marshe$,  there  can  be  rjp^Dpriety  in  referring  them 
to  the  agency  of  these,  when  they^jlp^li  to  exist  in  sickly  locali 
ties,  for  the  sickness  would  in  all  probability  have  arisen  had  they 
not  been  situated  there.  All  thi$.»at  first  sight  appears  plausible 
enough,  and  may  prove  perfectly  satisfactory  to  those  who  are  not 
well  posted  up  on  questions  of  the  kind ;  but,  011  examination,  the 
objection  will  be  found  to  rest  on  very  insecure  foundation.  For 
when  we  come  to  inquire  by  whom  periodic  fevers  are  referred  ex 
clusively  to  the  effluvia  of  marshes,  and  especially  by  whom  the 
opinion  is  obstinately  maintained,  we  easily  discover  that  no 
thing  of  the  kind  is  insisted  upon  by  any  physician  of  respectable 
authority ;  by  no  one,  indeed,  who  has  directed  his  thoughts  seriously 
to  the  etiology  of  febrile  complaints.  Doubtless,  a  large  majority 
of  medical  writers  and  inquirers  maintain  that  certain  forms  of 
fever  are  the  products  of  marsh  exhalations  properly  so  called. 
Doubtless,  also,  other  forms  of  the  same  disease,  including  the  ma 
lignant,  are  as  generally  regarded  as  due  to  the  action  of  exhala 
tions  of  some  sort.  But  no  one,  or  at  least  few,  among  those  whose 
opinions  are  worth  recording,  think  nowadays,  or  have  thought 
for  years  back,  of  viewing  the  existence  of  a  marsh  as  a  sine  qua 
non,  and  of  pertinaciously  affirming  that  febrile  miasmata  can  only 
be  evolved  from  a  paludal  soil.  Those,  therefore,  who  raise  an 
outcry  against  the  absurdity  of  such  an  opinion,  and  tax  their  oppo 
nents  with  generally  entertaining  it ;  those  especially,  who,  like  Dr. 
Dundas,  and  others  of  the  same  school,  write  long  dissertations 
8 


114  PNEUMONIA    AND 

with,  the  view  to  set  the  world  right  on  the  subject,  lose  much  valu 
able  time,  which  might  be  more  profitably  employed  in  making 
themselves  well  acquainted  with  the  true  state  of  the  question — a 
point  about  which  some  of  them  appear  to  be  lamentably  deficient — 
than  in  refuting  opinions  which,  if  ever  entertained,  have  long  since 
been  abandoned. 

That  such  is  really  the  case,  that  the  opinion  which  ascribes  all 
fevers  to  the  exhalations  of  marshes  solely,  is  not  entertained,  admits 
of  no  doubt.  Even  Dr.  Bancroft,  whose  work  appeared  some  forty 
years  ago,  and  would  almost  seem,  like  some  others  on  the  same 
subject,  to  have  been  writter^nvith  a  view  to  mystify  the  reader  on 
some  parts  of  its  contents,  continually  confounding  together,  as  he 
does,  several  distinct  fevers,  and  applying  to  them  the  one  name  of 
yellow  fever ;  even  Dr.  Bancroft,  I  say,  takes  pains  to  explain  that 
in  joining  the  epithet  raarsh.  or  marshy  (which  he  almost  invariably 
does)  to  the  term  miasnma,ftxhalation,  effluvia,  &c.,  and  in  con 
sidering  them  as  a  cause  of  fever,  he  does  not  mean  to  intimate  that 
such  miasmata,  &c.,  are  emitted  solely  by  marshes,  it  being  certain 
that  they  frequently  arise  from  soils  in  a  different  state,  but  only  to 
designate  the  quality  of  those  vapours  which  are  eminently  the  pro 
duct  of  marshy  ground.  Other  writers  have  pointed  out  the  impro 
priety  of  viewing  malaria  as  the  production  of  marshy  surfaces 
exclusively,  as  it  arises  often  in  arid  places  destitute  of  swampy 
surfaces.1  Lancisi  himself,  the  systematize!  of  the  knowledge  of 
the  times  on  malarial  effluvia,  the  discoverer  of  important  facts,  and 
the  able  expounder  of  etiological  observations,  who  is  often  referred 
to,  but  seldom  read,  was  very  far  from  believing  that  intermittent 
and  remittent  fevers,  which  he  knew  full  well  were  only  modifica 
tions  of  each  other,  proceed  from  the  emanations  of  marshy  grounds 
alone.  On  this  subject  he  expresses  himself  very  decidedly.2  He 
had  observed,  and  he  records,  that  from  the  soil  covered  by  the  ruins 
of  houses,  temples,  and  public  buildings,  from  grounds  rendered  damp 
and  filthy  by  the  obstructions  of  drains  and  sewers,  by  the  over 
flowing  of  the  Tiber,  &c.,  fever  had  arisen  and  prevailed  extensively. 
The  writings  of  Chervin,3  Boudin,4  Nepple,5  Maillot,6  Segond,7 

1  J.  Johnson  on  Tr.  Clim.  24;  Bryson,  190. 

2  De  Xoxiis  Paludum  Effluvius,  Oper.  i.  73. 

3  De  1' Identite"  des  Fievres,  d'Origiue  Paludeenues.  4  Geographic  Medicale. 

5  Trait  6  des  Fievres  Interm.  Simples  et  Pernicieuses. 

6  Traite  des  Fievres  ou  Irritations  Cereb.  Spin.  Interm. 

7  Mem.  sur  les  Fievres  de  Cayence. 


AUTUMNAL    FEVERS.  115 

Faure,1  &c.,  which  are  usually  referred  to  in  support  of  the  strictly 
paludal  origin  of  fevers  generally,  will  show  that,  even  in  the  opi 
nion  of  these  authors,  malarial  exhalations  of  various  degrees  of 
virulence  may,  and  do  often  proceed  from  surfaces  presenting  cha 
racters  very  different  from  those  appertaining  to  ordinary  marshes. 
Indeed,  at  the  present  day,  this  existence  of  malarial  exhalations, 
and  their  efficiency  in  the  production  of  fever,  independently  of  the 
presence  of  marshes,  properly  so  called,  and  their  elimination  from 
sources  of  various  nature,  and  differing  much  in  external  appear 
ance,  is  almost  universally  admitted — quite  so,  I  think,  by  all  who 
have  taken  pains  to  investigate  the  subject  in  all  its  bearings;  for, 
while  they  are  firmly  convinced  of  the  reality  of  the  morbific 
agency  of  such  effluvia,  they  know  that  fevers  prevail  sometimes 
even  in  arid  places  with  want  of  surface  water,  where  the  soil  is 
rocky,  or  sandy,  parched,  and  deficient^in  vegetation,  and  where,  in 
a  word,  circumstances  generally  arjjf  frv> appearance  at  least,  unfa 
vourable  to  the  decay  of  organic  matter".  On  this  subject,  the  facts 
recorded  by  Ferguson,  J.  Davy,  Craigie,  Brown,  Currie,  Humboldt, 
and  others,  can  leave  no  doubt.2  Nay  more,  it  is  almost  as  gene- 
rally  acknowledged,  that  the  malignant  forms  of  such  diseases  are 
never  produced  by  the  effluvia  of  genuine  marshes,  but  are  the 
products  of  other  miasmal  sources;  while,  on  the  contrary,  fevers 
known  to  arise  from  marsh  exhalations,  are  never  produced  by  the 
effluvia  which  occasion  the  other  forms  of  the  disease.  Hence, 
when  ordinary  or  malignant  autumnal  fevers  occur  in  places  where 
no  marshes  properly  so  called  exist,  it  is  of  no  avail  to  cite  the 
absence  of  these  as  an  evidence  of  erroneous  conclusions,  far  less 
of  absurdity,  on  the  part  of  those  who  attribute  such  fevers  to  mias 
matic  exhalations.  The  latter  writers  know,  fully  as  well  as  their 
opponents,  that  the  existence  of  a  marsh  is  not  indispensable  to  the 
manifestation  of  the  effect  in  question;  but,  unlike  them,  they  are 
perfectly  aware  of  the  fact  that  morbific  effluvia,  of  the  most  deadly 
character,  too,  may  and  do  arise  from  sources  which  bear  no  resem- 

1  Des  Fievres  Intcrm.  et  Cont.  1833,  and  Gaz.  Med.  1840. 

2  Ferguson  on  Marsh  Poison,  in  vol.  of  Recollections,  185  ;   Davy  on  Topography  of 
Mediterranean,  ii.   247,   248  ;   Humboldt,  Personal   Narrative,  iii.  ;  Charles   Darwin, 
Voyage  of  a  Naturalist,  ii.  129;   Carpenter  on  Periodicity,  New  Orleans  Journal,  iii. 
420 ;  Gildwell,  Essay  on  Malaria,  60,  61 ;  Craigie,  Practice  of  Physic,  i.  87  ;  Brown, 
Med.  Essays,  33,  3'J ;  Currie  on  Bilious  Fever,  55  ;   Tullock,   Sickness,  &c.  of  British 
Armv  on  West  Coast  of  Africa,  4,  &c. 


116  PNEUMONIA    AND 

blance  to  a  marsh.  In  the  words  of  an  intelligent  writer,  we  may 
say :  "  Marshes  and  swamps  are  for  from  being  the  only  sources  of 
miasmata."  "  The  foul  shores  of  the  sea ;  the  moist  slime  and  mud 
of  the  banks  of  great  rivers,  and  of  mill-ponds ;  the  mire  and  mud 
in  the  unpaved  streets,  ditches,  lanes,  and  passages  of  great  towns 
and  cities,  villages,  &c.,  particularly  the  cellars  and  damp  abodes 
where  the  poorer  classes  are  most  frequently  doomed  to  dwell — the 
moats  of  garrisons,  &c. ;  the  soil  where  certain  hospitals,  barracks, 
or  encampments  are  situated ;  the  wells  and  cellars,  damp  cells  and 
dungeons  of  prisons,  and  the  holds  of  ships,  are  all  calculated  to 
emit  pyrexial  effluvia  from  the  moist  earth,  mud,  and  filth,  which 
are  mostly  to  be  found  within  their  precincts."1 

The  non-detection  of  malaria  in  the  atmosphere  no  proof  of  its  non- 
existence  and  agency. — It  has  been  urged  time  after  time,  in  oppo 
sition  to  the  malarial  or%j.n  of  fever,  that  the  existence  of  the 
effluvia,  to  the  agency  of  which  the  disease  is  ascribed,  has  never 
been  proved — that  their  presence  in  the  atmosphere  has  been  in 
ferred  from  the  effects  observed,  rather  than  positively  demon 
strated — that  they  have  so  far  eluded  detection ;  and  that  the  air  of 
sickly  localities,  whenever  subjected  to  chemical  analysis,  has  been 
found  to  contain  the  same  ingredients,  and  in  nearly  the  same  pro 
portions,  as  that  of  salubrious  places.  Much  of  this  is  doubtless 
true,  and  will  not  be  denied  by  any  one  who  has  endeavoured  to 
make  himself  acquainted  with  the  state  of  knowledge  on  the  sub 
ject.  All  are  aware,  for  the  fact  has  been  often  referred  to,  that  the 
experiments  of  Gattoni,  and  others,  led  to  the  conclusion  that  the 
air  of  the  marshes  of  Fuentes  is  as  pure  as  that  of  Mount  Legone,2 
one  of  the  Grison  Alps,  at  an  elevation  of  8,040  feet  above  the 
level  of  the  sea.  They  are  aware  that,  at  Martinique,  Moreau  do 
Jonnes  found  no  difference  between  the  chemical  composition  of 
the  air  of  Mount  Tartanson,  at  a  height  of  some  six  hundred  feet 
above  the  level  of  the  sea,  and  of  the  valley  of  Case  Navire ;  and  that 
the  atmosphere  of  the  wards  of  the  hospital  of  Fort  Royal,  during 
the  prevalence  of  yellow  fever,  differed  from  neither.3  They  know 
that  Julia  de  Fontenelle  could  detect  no  deleterious  gases  or  foreign 
chemical  ingredients  in  the  atmosphere  of  infected  localities — that 

1  Blackmore  on  Infection,  92. 

2  Memoirs  de  la  Societe  de  Medecinc,  x.  109.   Art.  VI. 

3  Monographic  de  la  Fievre  Jaune,  229. 


AUTUMNAL   FEVERS.  117 

the  latter  did  not  vary  from  that  of  healthy  places  in  any  of  the 
principles  which  chemical  analysis  enables  us  to  discover — a  result 
he  obtained  in  the  marshes  of  Cercle  near  Narbonne,  at  the  pond 
of  Pudre,  at  Salces,  Salanque,  Capestang,  Cette,  at  Barcelona  during 
the  fever  of  1821,  and  at  Paris  during  the  cholera  of  1833.1  They 
also  know  that  a  distinguished  chemist  and  professor  in  the  school  of 
Montpellier,  Berard,  reached  the  same  conclusions  from  his  experi 
ments  on  the  pestiferous  air  of  the  marshes  on  the  coast  of  Cette;2 
and  that  Desaye  obtained  the  same  elements  in  the  most  confined 
marshes  as  on  the  most  exposed  hills.3 

They  are  aware  that,  according  to  more  recent  authorities,  the 
proportion  of  oxygen  is  the  same  in  very  high  regions  as  it  is  near 
the  surface  of  the  earth.4  They  are,  besides,  conversant  with  the 
fact  that,  in  more  than  one  hundred  analyses  made  in  Paris  and  its 
environs,  the  least  quantity  of  oxygen  found  was  20.913 ;  the  great 
est,  20.999,  and  the  mean,  20.96;  that  a$%lontpellier,  Lyons,  Berlin, 
Madrid,  in  Normandy,  and  Switzerland,  the  quantity  varied  from 
20.903  to  21.000;  that  in  the  port  of  Toulon,  in  the  middle  of  the 
Mediterranean,  at  Algiers,  in  the  Atlantic,  between  Liverpool  and 
Yera  Cruz,  the  results  were  the  same;  that  in  the  village  of  Gualla- 
bamba  (Republic  of  Equador),  the  quantity  was  discovered  to  be 
20.960,  and  on  the  summit  of  Pichincha,  20.949  :  20.988 ;  that,  in 
eleven  specimens  of  air  collected  in  the  southern  seas,  only  two 
gave  results  differing  somewhat  from  the  above — that  of  the  Gulf 
of  Bengal,  where  the  quantity  was  20.46  :  20.45 ;  and  of  Ganges, 
where  it  amounted  to  20.390  :  20.387 ;  and  that  in  the  Polar  Seas, 
according  to  Captain  Boss,  similar  observations  Avere  made  in  re 
spect  to  the  composition  of  the  atmosphere.5  They  perceive  from 
these  results,  as  well  as  from  those  obtained  by  Levy  and  Brunsen, 
that  the  variations  in  the  composition  of  the  atmosphere,  wheresoever 
examined,  are  exceedingly  limited,  the  difference  in  regard  to  the 
volume  of  oxygen  being  from  20.9  to  21 ;  that  the  composition  of 
the  air  is  the  same  in  the  highest  attainable  strata  of  the  latter  as 
on  the  surface  of  the  earth ;  and  that  if,  in  some  instances,  espe- 

1  Recherches  Hist.  Chim.  et  M<$d.  sur  Fair  Mare'cageux,  91,  £c.     See  also  his  trans 
lation  of  Mojon's  Essay  on  the  Aninialcular  Origin  of  Cholera.  3,  4. 

2  Julia,  op.  cit.  93.  3  Cyclop,  of  Pract.  Med.  iii.  60. 

4  Becquerel,  Des  Climats  et  de  1' Influence  qu'ils  exercent  sur  les  Sols  boises,  &c. 
2,  3,  4. 

5  llegnault,  Comptes  Rendus,  &c.,  de  1' Academic  des  Sciences,  xxxiv.  867. 


118  PNEUMONIA    AND 

cially  in  hot  climates,  the  quantity  of  oxygen  lowers  to  20.3,  with  a 
variation  of  about  0.020  of  its  volume,  it  may  be  doubtful  whether 
such  a  small  difference  can  have  any  influence  on  the  phenomena  of 
organic  life  or  on  health. 

"  The  Almighty,"  says  a  well-informed  writer,  "  has  not  permitted 
the  chemist  to  discover  the  nature  of  such  attenuated  exhalations : 
they  elude  all  detection ;  for  if  he  take  a  volume  of  stagnant  air 
from  the  foul  '  plague  Avard'  of  an  Egyptian  hospital,  Avhere  croAvds 
of  living  and  cadaverous  beings  are  hourly  stricken  with  the  ago 
nies  of  death,  his  analysis  will  prove  it  to  contain  the  exact  propor 
tion  by  weight  and  by  measure  of  elements  and  compounds,  as 
those  contained  in  an  equal  volume  of  a  balmy  breeze  taken  from 
a  free  and  open  English  valley,  Avhere  all  are  smiling  Avith  the  in 
estimable  blessing  of  •'health,  and  glowing  with  its  bronzed  and 
ruddy  hues."1 

Fever  not  due  to  the  action  of  any  known  gases. — AAvare  of  all  these 
failures  in  the  attempt  to  refer  th|  cause  of  fever  to  any  dispropor 
tion  in  the  natural  gaseous  compounds  of  the  atmosphere,  \ve  can 
find  no  difficulty  in  acknowledging  the  erroneousness  of  such  opin 
ions  as  that  of  Dr.  Currie,  Avho,  basing  his  conclusion  on  sundry 
long-forgotten  experiments  of  Vanbreden,  thought  that  the  insalu 
brity  of  low  and  moist  places  is  not  owing  to  invisible  miasma  or 
noxious  effluvia,  but  to  a  deficiency  of  oxygen  resulting  from  ani 
mal  and  vegetable  decomposition  ;2  or  of  the  once  famous  doctrine 
of  the  Septon — an  undiscovered  compound  of  azote  and  oxygen,  as 
propounded  and  defended  by  the  late  Professor  Mitchell,  of  NCAV 
York ;  or  more  recently,  of  the  theories  of  our  countryman,  Kumph, 
of  Giannmi,  and  others  too  numerous  to  mention.  Few,  also,  who 
have  reflected  seriously  on  the  subject  will  feel  disposed  to  lend  a 
willing  ear  to  the  theory  which,  teaches  that  the  cause  of  fever  must 
be  sought  in  the  admixture,  in  minute  or  larger  proportion,  of  sun 
dry  gases,  with  or  without  addition  of  other  substances — carbon 
ated  hydrogen,  carbonic  acid  gas,  ammoniacal  gas,  hydrosulphuric 
acid  gas,  phosphuretted  hydrogen,  &c.  ;3  for,  Avere  it  true,  that  these 

1  Griffith's  Chemistry  of  the  Four  Seasons,  225,  226. 

2  Philadelphia  Philosophical  Transactions,  iv.  135. 

3  Ramazzini;   Volta  Opera,  3  Florence,  1816;   Dumas;  Pallas,  210;   Faust,  Amer. 
Journ.   vi.   38;   Thenard   and   Dupuytren   in   Monfalcon,    54;     Baumes,    Emanations 
Marecageuses,  in  Monfalcon,  53,  54;  Deslandes,  Diet,  de  Mod.  prat,  article  Emanation; 


AUTUMNAL    FEVERS.  119 

gases  have  been,  or  may  be,  detected  in  the  atmosphere  of  sickly 
localities,  it  would  not  follow  that  we  must  ascribe  fever  to  their 
agency,  seeing  that  though  often  unpleasant  to  the  smell,  and  some 
times  injurious  or  even  fatal  in  their  tendencies,  they  do  not  pro 
duce  phenomena  analogous  to  those  of  the  diseases  in  question, 
even  when  absorbed  in  large  quantities ;  while  those  they  do  occa 
sion  present  always  a  widely  different  garb ;  and  that,  as  they  do 
not  produce  the  symptoms  of  true  pyrexial  complaints  when  ab 
sorbed  in  large  quantities,  they  are  not  likely  to  occasion  them 
when  received  in  such  small  proportion  as  to  elude  detection.  If 
they  were  the  legitimate  cause  of  fever,  and  the  active  agents  of 
miasma,  it  is  impossible  to  understand  how  the  fact  could  not  have 
been  demonstrated  during  wide-spreading  and  highly  malignant 
epidemics,  when  the  cause  was  acting  with  intense  energy,  and  must 
have  existed  in  sufficiently  large  proportion  to  be  detected  by  some 
or  other  of  the  means  within  our^^ifSpb:.  It  should  be  borne  in 
mind,  too,  that,  when  fatal,  their  effects  are  rapid,  often  instanta 
neous  ;  that  when,  on  the  contrary,  they  do  not  occasion  death,  the 
immediate  results  very  usually  pass  off,  leaving  the  sufferer  some 
times  more  or  less  debilitated,  but  without  one  febrile  symptom ; 
and  that  many  of  them  are  appreciable  to  the  senses,  and  if  existing 
in  injurious  proportions,  would  soon  be  detected.  It  is  not  less 
true,  and  to  the  purpose,  that  such  gases  may  be  produced  or  exist 
anywhere,  in  sickly  as  in  healthy  localities;  while  fevers,  on  the 
other  hand,  occur  in  certain  places  only,  within  certain  latitudes,  and 
under  special  circumstances;  that,  in  many  situations,  where  fever 
prevails  extensively,  the  existence  of  some  of  those  gases,  to  any 
notable  or  injurious  amount,  has  not  only  not  been  demonstrated, 
but  is  impossible,  or  improbable ;  and  vice  versa,  that,  in  places  where 
they  are  abundantly  produced,  fever  never  shows  itself.  Even 
hydrosulphurous  acid  gas  itself,  on  which  so  much  has  been  said 
lately  in  France  by  M.  Chevreul,  in  England  by  Daniel,  and  in  this 
country  by  Dr.  Gardiner,  in  its  relation  to  the  etiology  of  autumnal 
fevers,  will  not  be  found,  on  reflection,  to  afford  much  aid  in  account 
ing  for  those  diseases.  True,  it  may  be,  as  Chevreul  has  shown 
by  direct  and  positive  experiments,  that  this  gas  is  formed  by 

Balme,  Traite  dc  la  Contagion,  305;  Chevreul,  Bulletin  de  1'Acad.  de  Mod.  xviii.  692  ; 
Daniell,  Lond.  Med.  Gaz.  xxviii.  609,  700;  Gardiner,  Amor.  Journ.  X.  S.  v.  279;  Me- 
lier,  Mem.  de  1'Acad.  de  Med.  xiii.  492;  Carriere,  Le  Climat  de  Pltalie,  311,  312; 
Humboldt,  Personal  Nar.  iii.  188. 


120  PNEUMONIA    AND 

the  action  of  the  sulphnrets  contained  in  water  or  the  earth  on 
organic  matter,  whether  animal  or  vegetable,  with  which  they  come 
in  contact  (by  which  these  nearly  insoluble  and  inoffensive  sub 
stances  are  converted,  through  means  of  the  combination  of  oxygen 
with  the  azotized  matter,  into  soluble  sulphurets),  a  result  which  has 
enabled  M.  Fontan1  to  explain  the  formation  of  sulphurous  mineral 
waters.  True  it  is,  also,  that  those  sulphates,  together  with  organic 
matter,  are  found  in  most,  if  not  in  all  sickly  localities,  and  hence 
that  the  gas  in  question  is  also  encountered  there  in  a  greater  or 
less  amount ;  but  it  is  not  less  true  that,  in  many  places,  subject  to 
fevers,  and  during  wide -spreading  febrile  epidemics,  of  various 
forms,  from  the  simple  intermittent  to  the  malignant  yellow,  the 
presence  of  this  supposed  agent  is  not  evident  to  the  senses,  or  to 
chemical  reagents,  and  must,  if  it  exist  at  all,  do  so  in  so  small  a  pro 
portion  as  to  be  inert.  It  s.bpiild  be  borne  in  mind,  besides,  that 
hydrosulphuric  acid  gas  pro^s  innocuous  in  factories  and  bathing 
establishments2  where  it  abounds;  and  that  its  presence  in  the 
African  rivers  and  circumambient  air,  on  which  so  much  stress  was 
laid  by  Dr.  Daniell  and  others,3  has  been  positively  disproved — 
water  newly  taken  up,  or  kept  in  bottles,  hermetically  closed,  never 
giving  evident  signs  of  that  presence,  which  is  evidently  due,  after 
awhile,  to  the  putrefaction  of  the  organic  matter  contained  in  the 
water.4  In  a  word,  there  is  not  the  most  distant  probability  that 
malaria  will  ever  be  found  to  owe  its  morbific  agency  to,  or  consist 
in  any  extraneous  gas  floating  in  the  atmosphere,  or,  that  fevers  are 
due  to  an  excess  or  deficiency  of  one  or  more  of  the  known  con 
stituents  of  the  latter. 

Not  true  that  noticing  is  found  in  the  atmosphere  of 'sickly  localities. — 
All  this  we  must  admit ;  but  while  doing  so,  we  can  find  no  valid 
reason  for  denying  the  very  existence  of  a  specific  febrific  cause ; 
for  from  the  circumstance  that  malaria  cannot  justly  be  identified 
with  any  of  the  gases  above  mentioned,  it  does  not  follow  that  the 

1  Bulletin  do  1'Acad.  x.  602,  &c. 

2  Annales  d'llygiene,  xi.  2(JO ;   Brocchi  Stato  Fisico  di  Roma,  254,  &c. ;  J.  K.  Mit 
chell,  28. 

3  Loc.  cit. 

4  M'Williams,  Medical  History  of  the  Expedition  to   the  Niger,  &c.  172;   Tritchett, 
Some  Accounts  of  the   African  Remittent   Fever,   117;   Kdin.  Journ.   (>•'>,   442;   Arm 
strong,  Sulphuretted  Hydr.  and  its  Antidotes,  Naut.  Mag.  1842,  378,  &c. 


AUTUMNAL    FEVERS.  121 

atmosphere  of  sickly  localities  contains  no  extraneous  material  to 
which  autumnal  fevers  are  to  be  ascribed.  Certain  it  is,  that  those 
who  enter  into  the  investigations  unbiased  by  preconceived  notions 
will  not  lose  sight  of  certain  facts  which  will  probably  one  day  be 
found  entitled  to  the  particular  attention  of  the  medical  inquirer, 
and  lead  ultimately  to  useful  conclusions  on  this  important  matter — 
not,  perhaps,  by  giving  us  at  once  correct  notions  respecting  the 
real  nature  of  the  cause,  or  enabling  us  to  seize  the  poisonous  mat 
ter  and  subject  it  to  chemical  analysis,  but  by  determining  its  gene 
ral  nature  and  the  class  of  substances  to  which  it  belongs.  The 
medical  reader  will  recollect  that  %foscati,  the  first  who  suggested 
the  idea  of  condensing  the  water  dissolved  in  the  atmosphere  of 
insalubrious  places  with  a  view  to  discover  the  effluvial  principle, 
obtained  by  that  process,  in  sundry  experiments  he  instituted  at 
Milan,  on  the  air  of  rice  grounds,  au'd  of  the  wards  of  the  large 
hospital  of  that  city,  deposits  of  a^Jbcculent  matter,  emitting  a 
cadaverous  odour.1  Brocchi,  at  Rome,  found  albuminous  flakes  (ani 
mal  matter)  in  the  dews  of  the  Pontine  marshes.2  In  1812,  Rigaud 
de  Lisle,  experimenting  on  the  marshes  of  Languedoc  and  Pro 
vence,  collected  a  quantity  of  the  dews  which,  when  examined 
some  five  or  six  months  after  by  Yauquelin,  was  found  to  contain 
flakes  of  animal  matter;  while  the  experiment  of  the  former  on  fresh 
dews,  collected  from  marshy  surfaces,  gave  a  somewhat  different  re 
sult,  exhibiting,  as  they  did,  common  air  without  admixture  of  any 
gas,  but  containing  alkaline  salts,  with  vegetable  and  animal  sub 
stances.3  Dumas,  and  before  him  Yolta,  found  an  organic  substance 
combined  with  the  gases  disengaged  from  stagnant  water.  Julia 
de  Fontenelle  and  Herpin,  obtained  results  differing  but  little  from 
those  recorded  by  Brocchi,  so  far  as  regards  the  flocculent  or  in 
organic  matter,  while  in  common  dew  nothing  of  the  kind  was 
discovered.4  Agreeably  to  the  first  of  these  experimenters,  the 
air  of  marshes  may  be  inodorous,  but  if  kept  six  months,  it 
acquires  a  nauseous  smell — an  effect  not  noticed  in  common  air.5 
Ozanam  also  found  "a  substance  apparently  mucous,  which  emitted 

1  Compendio  di  Cognoz.  Veterin,  81;  Monfalcon,  59;   Levy,  Hygiene,  2d  ed.  i.  444. 

2  Dello  Stato  Fisico  del  Suolo  di  Roma,  259-275. 

3  Annnles  Cliniques  de  la  Soc.  Trat,  de  Montpellier,  xliv.  286;  Julia,  loc.  cit.  83-84. 
An  account  of  these   experiments  was   addressed  to  Pictet,   and  published  in  the 
Bibliotheque  Universclle. 

4  Julia,  80-7.  5  Ibid.  90. 


122  PNEUMONIA    AND 

a  very  fetid  odour."1  Boussingault,  whose  experiments  were  made 
in  the  department  of  Ain  (France),  in  1819,  and  subsequently  in 
South  America,  on  the  banks  of  the  Taricagua,  and  at  Cartago, 
in  the  valley  of  the  River  Cauca,2  demonstrated  also  the  presence 
of  organic  matter  in  the  air  deposited  with  the  dew.  This  matter 
imparted  a  dark  hue  to  concentrated  sulphuric  acid  exposed  to 
miasmata  during  the  night — the  quantity  varying  according  to 
the  unhealthiness  of  the  seasons  at  which  the  experiments  were 
made.  Thenard  and  Dupuytren  found  that  the  carburetted  hy 
drogen  obtained  from  marshy  grounds,  when  passed  through 
water,  deposited  therein  a  peculiar  putrescible  matter— a  result 
not  obtained  from  the  same  gas  disengaged  in  the  ordinary  way.3 
In  a  communication  made  to  the  French  Academy  of  Sciences,  in 
1847,  respecting  sundry  observations  and  experiments  made  by 
him  on  the  condensation  of  ..fogs  and  dews,  M.  Gasparn  states  that 
from  these  a  peculiar  matt^^was-  obtained,  which,  on  trial,  was 
found  detrimental  to  health,  and  fatal  to  sheep.  The  same  results 
were  obtained  by  M.  Malagutti,  an  Italian  chemist.4 

In  1828,  Messrs.  Meirieu  condensed  the  dews  collected  over  cer 
tain  marshes  situate  in  the  department  of  the  Gard,  and  obtained 
therefrom  a  peculiar  substance  possessing  acid  properties.5 

Liebig  tells  us  that  "all  the  observations  made  upon  gaseous 
contagious  matters,  prove  that  they  also  are  in  a  state  of  decompo 
sition.  When  vessels  filled  with  ice  are  placed  in  air  impregnated 
with  gaseous  contagious  matter,  their  outer  surfaces  become  covered 
with  water  containing  a  certain  quantity  of  this  matter  in  solution. 
This  water  soon  becomes  turbid,  and,  in  common  language,  putre 
fies  ;  or,  to  describe  the  change  more  correctly,  the  state  of  decom 
position  of  the  dissolved  contagious  matter  is  completed  in  the 
water.'"5  Finally,  a  physician  of  our  own.  country,  Dr.  Hume,  Pro 
fessor  of  Elemental  Philosophy  in  the  State  Military  Academy  of 

1  Hist.  MecL  des  Maladies  Epid.  i. 

2  Recherches   sur  la  composition  de   1'atmosphere,  sur  la  possibilite  do   constater 
rexistence  des  Miasmes,  Ann.  dc  Chiniic  et  de  Phys.  Ivii.  148,  &c. ;   Guz.   Med.  Aug. 
1C,  1834;    Am.  J.  xv.  544;   do.  xix.  203;   Archives,  2d  S.  v.  G41. 

a  Monfalcon,  54. 

4  Becquerel,  Traite   d'llygiene,   174,  183;   Gaz.  Med.  de  Paris,  ii.  3d  series,  1817, 
p.  22;   Anglada,  Traite  de  la  Contagion,  i.  34-5. 

5  Influence  des  Mia«mes  Marecageux,  sur  I'Economic  Animale,  Montpellicr,  1820, 
p.  0,  referred  to  by  Anglada,  op.  cit.  p.  34. 

6  Agricultural  Chemistry,  Loud.  ed.  373  ;   Am.  cd.  407. 


AUTUMNAL    FEVERS.  123 

Charleston,  during  some  experiments  made  by  him  in  that  city  a  few 
years  ago,  discovered  the  existence  of  an  organic  matter  suspended 
in  the  atmosphere  of  localities  infected  with  the  poison  of  the  yellow 
fever.  "Whether  animal  or  vegetable,"  says  Dr.  II.,  "it  is  impos 
sible  to  determine ;  but  I  am  inclined  to  suspect  the  presence  of 
both,  as  the  odour  was  more  like  that  of  animal  matter,  while  the 
charring  and  subsequent  combustion  of  the  carbon  was  indicative  of 
vegetables.  The  positive  detection  of  organic  matter  in  the  con 
densed  water  of  a  presumed  infected  cellar,  in  a  decidedly  infected 
district,  is  a  new  fact  in  the  etiology  of  the  disease,  arid  points  dis 
tinctly  to  the  origin  of  our  yellow  fever."1 

Whether,  in  the  present  state  of  knowledge  on  the  subject,  we 
can  unhesitatingly  connect  the  production  of  malarial  fevers  of  all 
grades  and  types,  with  the  existence  of  azotized  flakes  in  the  atmo 
sphere — attributing,  with  Julia  (pp.  1%J>,  153),  JTourcroy,2  and  others, 
the  morbid  effects  noticed  in  sickly  -JiUfclities  to  particles  of  animal 
and  vegetable  matter  in  a  state  of  putrefaction,  and  mixed  with, 
and  floating  in,  the  air — I  will  not  pretend  to  decide  in  a  very  posi 
tive  manner.  Perhaps  the  fact  adduced  on  some  occasions,  that 
analogous  discoveries  have  been  made  in  air  issuing  from  noted 
sources  of  vegetable  and  animal  putrefactions,  and  which,  neverthe 
less,  did  not  give  rise  to  malarial  fevers,  and  that,  on  the  contrary, 
chemists  have  not  unfrequently  failed  to  detect  azotized  flakes  in  the 
air  of  localities  where  fever  prevails  more  or  less  extensively,  may 
deter  us  from  regarding  them  as  exclusive  agents  in  the  production 
of  those  diseases.  But  be  this  as  it  may,  the  results  obtained  in  a 
large  majority  of  the  trials  made  in  various  situations,  prove  very 
clearly  that  in  marshy  places,  during  the  precipitation  of  dew,  flakes 
of  organic  matter  are  deposited  with  it ;  that,  in  many  instances,  a 
similar  matter  has  been  obtained  in  the  atmosphere  of  infected 
places;  and  surely  the  frequency  of  the  occurrence,  taken  in  con 
nection  with  other  circumstances  that  will  be  noticed  presently, 
justifies  the  conclusion  that  the  researches  of  chemists  have  not 
been  as  barren  of  results  as  is  usually  affirmed  by  the  opponents  of 
malaria,  and  that  the  azotized  matter  obtained  during  the  prevalence 
of  fever  may  very  reasonably  be  supposed  to  have  some  agency  in 
the  production  of  the  latter. 

1  Charleston  Mcd.  J.  v.  24-6. 

2  Putrefaction  des  Substances  Animales,  quoted  by  Julia,  122. 


124  PNEUMONIA    AND 

Chemists  not  more  successful  in  discovering  other  morbid  poisons  in 
the  atmosphere. — But  let  us  admit  that  chemists  have  failed,  in  all 
places,  and  under  all  circumstances,  to  detect  in  the  atmosphere  of 
insalubrious  localities  something  tangible  to  which  the  causation  of 
fever  may  j  ustly  be  ascribed ;  let  us  also  admit,  for  the  sake  of  argu 
ment,  that  there  exists  no  connection,  as  cause  and  effect,  between 
the  azotized  and  putrid  flakes  above  referred  to,  and  the  diseases  in 
question,  and  that  we  are  as  far  off  now  as  our  forefathers  were 
centuries  ago,  from  the  possibility  of  demonstrating,  in  a  satisfactory 
manner,  the  nature  of  the  malarial  poison,  and  to  prove  its  inde 
pendent  existence;  it  is  doubtful,  as  every  attentive  reader  will 
perceive,  whether  the  opponents  of  the  malarial  origin  of  autumnal 
fevers  can  derive  from  that  acknowledgment  an  overwhelming  and 
convincing  argument  in  favour  of  their  views.  He  must  at  once  see, 
that  if  we  deny  the  existence  of  febrile  miasmata  on  the  ground 
that  no  one  has  as  yet  satisfactorily  succeeded  in  detecting  them 
in  the  atmosphere,  we  shall  be  called  upon  to  make,  for  the  same 
reason,  and  for  the  sake  of  consistency,  other  denials,  for  which,  I 
presume,  few  physicians,  whatever  be  their  opinions  on  the  subject 
before  us,  can  be  prepared.  Let  us  not  forget  that  no  one  has  as 
yet  been  able  to  detect  the  poison  of  other  zymotic  diseases — small 
pox,  scarlatina,  measles,  influenza,  hooping-cough,  typhus,  Asiatic 
cholera,  plague,  &c.,  contagious  or  otherwise — and  yet  we  know  that 
they  must  at  times  float  in  the  air,  since  they  produce  their  respect 
ive  morbid  effects  in  individuals  who  breathe  that  tainted  medium; 
and  under  circumstances,  too,  which  forbid  the  supposition  that 
those  attacked  could  have  received  the  infection  by  direct  exposure 
to,  or  contact  with,  the  sick.  Liebig,  with  all  the  facilities  afforded 
by  the  appliances  of  the  Giessen  laboratory,  and  all  the  uncommon 
dexterity  and  analyzing  powers  he  is  known  to  possess,  tried  the 
experiment,  but  failed.  The  aroma  of  flowers,  and  other  odorous 
substances,  betray  their  presence  in  the  atmosphere,  through  their 
effects  on  the  olfactory  nerves ;  and  yet,  Cavendish  and  other  able 
operators  found  no  difference  between  pure  air  and  that  in  contact 
with  such  substances ;  and  were  it  not  for  he  effects  in  question,  and 
sometimes  for  the  impression  they  produce  on  the  nervous  system 
at  large,  they  would  remain  undiscovered.  We  are  told  by  Lind, 
that  turners,  in  working  the  wood  of  the  rnanchineel  tree,  would 
be  severely  affected,  did  they  not  securely  guard  against  breathing 
its  poison.  A  field  of  poppies  has  been  known  to  induce  a  sleepy 


AUTUMNAL   FEVERS.  125 

disposition  in  the  bystanders.  Van  Swieten,  in  the  early  part  of 
his  life,  suffered  repeatedly  a  temporary  loss  of  memory  from  the 
vicinity  of  a  plant  to  him.1  The  air  collected  in  the  wards  of  the 
hospitals  of  Milan,  Paris,  Barcelona,  and  other  places,  in  dissecting- 
rooms,  in  knackeries,  in  cemeteries,  in  the  galleries  of  a  crowded 
theatre,  from  cesspools,  culverts,  stables,  or  collections  of  putrid 
meat,  must  naturally  be  supposed  to  be  impure ;  nevertheless,  as 
seen,  it  does  not  differ  from  the  common  atmosphere  in  any  mate 
rial  point.  In  some  of  these  instances,  a  little  ammonia  or  carbonic 
acid  may  be  found  ;  but  the  result  is  not  constant,  and  is,  besides, 
of  no  importance,2  for  the  deleterious  properties  of  infection  con 
tinue  unimpaired  after  these  substances  have  been  removed.  Nor 
can  chemists  discover  any  difference  between  the  pure  air  of  the 
loftiest  mountain  ranges,  and  the  air  through  which  a  dog  can  tell 
that  a  horse,  a  fox,  or  a  man  has  passed.3  Experiments  have  made 
it  clear  that  some  morbific  vapours  may  be  diffused  in  the  atmo 
sphere  in  such  attenuated  proportions  as  not  to  be  detected  by  the 
smell  or  by  chemical  analysis,  and  yet  occasion  baneful  and  even 
deadly  effects,  not  only  on  some  of  the  lower  order  of  animals,  but 
also  on  the  more  elevated  in  the  zoological  scale. 

In  addition,  it  may  be  remarked  that  medicines,  even  purgatives, 
are  sometimes  found  to  act  through  the  medium  of  the  air,  in  which 
they  cannot,  on  analysis,  be  detected.  In  all  these  instances,  the 
substances  in  question,  though  defying  the  scrutinizing  efforts  of 
the  experimental  chemist,  are  well  known  to  exist  in  the  atmo 
sphere  ;  some  by  their  peculiar  odour,  others  by  having  been  placed 
there  purposely,  and  most  of  them  by  their  effects  on  the  economy ; 
and,  surely,  if  such  is  the  case  in  regard  to  those  substances,  there 
can  be  no  reason  to  refuse  admitting  others  possessing  toxicolo- 
gical  properties  the  same  privilege  of  concealment,  and  to  deny 
their  presence  on  the  score  of  their  not  being  detected  on  chemical 
analysis,  seeing,  as  we  do,  that  effects,  palpable  enough  in  all  con 
science,  follow  closely  on  exposure  to  an  atmosphere  which  many 
circumstances  lead  us  to  regard  as  being  contaminated.  From 
analogy,  therefore,  we  may  conclude,  that  though  escaping,  in  con 
sequence  of  their  inodorousness,  and  the  inefficiency  of  our  means 
of  analysis,  the  notice  of  casual  observers,  and  no  less  the  researches 

1  Means  of  Preserving  the  Health  of  Seamen,  24-5,  note. 

2  Guyton  Morveau,  Ann.  de  Chimie,  xxxix.  84. 

3  Barton,  Report  to  the  State  Medical  Society  of  the  State  of  Louisiana,  26. 


126  PNEUMONIA    AND 

of  the  chemist;  malarial  effluvia  may,  nevertheless,  float  in  the 
atmosphere,  in  sufficient  amount  and  in  a  sufficient  state  of  con 
centration  to  manifest  their  presence  by  occasioning  their  specific 
morbid  effects — febrile  diseases — in  individuals  exposed  to  the  in 
fluence  of  the  atmosphere  which  they  serve  to  contaminate. 

To  those  who  adduce  such  an  objection,  it  may  be  remarked  that 
no  one  will  venture  to  doubt  or  deny  the  existence,  in  the  matter 
obtained  from  a  variolous  or  vaccine  pustule,  or  in  the  pus  of  a 
chancre,  or  in  any  other  animal  poison,  of  a  particular  virus  capa 
ble  of  infecting  the  system,  and  reproducing  in  it  a  specific  disease 
similar  to  that  whence  that  virus  proceeds.  The  variolous  matter 
produces  smallpox,  the  vaccine  matter  occasions  cowpox,  the  pus 
of  chancre  gives  rise  to  syphilis,  £c.  Well,  let  them  inquire  how 
far  chemistry  has  gone  in  the  way  of  discovering  the  nature  of 
these  particular  poisons,  and  the  particular  element  through  which 
they  derive  their  toxicoj.ogical  powers,  and  they  will  find  little 
calculated  to  satisfy  their  curiosity.  On  this  subject  the  science, 
so  far,  has  not  effected  much  more  than  it  has  in  regard  to  the 
atmosphere  of  malarial  localities.  The  analysis  of  the  pustules  of 
mild  and  simple  smallpox,  gives  only  fibrine,  mucus,  hydrochlorate 
of  soda,  sulphate  of  potassa,  phosphate  of  lime,  and  water.  That  of 
pus  furnished  by  smallpox  complicated  with  petechial  eruptions, 
gives  the  following  materials:  Fibrine,  mucus,  hydrochlorate  of 
soda,  hydrocyanuret  of  soda,  sulphate  of  potassa,  phosphate  of  lime, 
and  water.1 

Not  one  of  these  materials  can  by  itself  produce  smallpox,  how 
ever  introduced  into  the  system.  Combine  them  together  artifi 
cially,  in  whatever  proportion  you  please,  and  you  will  not  be  likely 
to  occasion  the  effect.  And  yet  they  are  the  only  materials  found 
by  the  chemist;  while  the  particular  something  which  imparts  an  in 
dividuality  to  the  poison,  and  constitutes  it  a  specific  agent,  has 
fled.  \Vill  any  one  deny,  on  that  account,  its  presence  during  the 
analysis?  The  same  may  be  said  in  relation  to  vaccine,  the  pre 
dominating  elements  of  which  consist  in  water  and  albumen ;  though, 
on  more  minute  examination,  it  is  found  to  contain  a  matter  similar 
to  osmazome,  chlorate  of  sodium,  chlorate  of  potassa,  and  phosphate 
of  lime.  Here,  again,  the  peculiar  something  has  vanished.2  Similar 

1  Journal  de  Cliimic  Medicale,  1828,  iv.  488;   Anglada,  Tr.  de  la  Contagion,  i.  205. 

2  L'lleriticr,  Traite  dc  Cliiraic  Pathologique,  612;  Anglada,  i.  204. 


AUTUMNAL   FEVERS.  127 

remarks  are  applicable  to  the  virus  of  chancre,  of  gonorrhoea,  of 
hydrophobia,  of  glanders,  as  also  to  the  extensive  class  of  vege 
table  poisons,  all  of  which,  when  chemically  analyzed,  furnish,  in 
various  combinations  and  in  various  proportions — the  first  the  ordi 
nary  constituent  elements  of  animal,  the  other  those  of  vegetable 
substances — but  in  no  instance  present  us  with  the  peculiar  ingre 
dient  which  imparts  to  each  of  those  products  its  specific  poisonous 
property. 

Again,  it  has  been  said  that  the  blood  of  individuals  affected  with 
measles  communicates  the  disease,  when  inserted  into  incisions 
made  in  the  skin,  and  kept  there  by  mieans  of  cotton.  I  say,  it  has 
been  said ;  for  though  the  experiments  which  Dr.  Francis  Home,  of 
Edinburgh,  instituted  on  the  subject,  about  the  middle  of  the  last 
century,  and  those  of  Speranza,  during  the  epidemic  of  Milan,  in 
1822,  would  seem  to  justify  the  conclusion,  and  though  the  high 
authority  of  Stoll  may  be  adduced  in  its  favour,1  the  success  of  this 
inoculation  is  yet  open  to  doubt.  But,  admitting  it  to  be  true,  and 
admitting,  also,  what  can  scarcely  be  denied,  that  in  measles,  as  well 
as  in  the  whole  tribe  of  zymotic  diseases,  the  blood  is  the  vehicle  of 
the  poison,  in  some  form  or  other,  it  is  a  well-ascertained  fact  that, 
in  the  present  state  of  the  science,  chemistry  is  powerless  in  its  en 
deavours  to  discover  in  that  fluid  any  anomalous  element,  in  the 
least  indicative  of  the  presence  there  of  the  toxicological  agent  to 
which  the  disease  is  due.2  Examine  also  the  blood  of  individuals 
labouring  under  scarlatina,  smallpox,  vaccine,  typhus,  typhoid, 
cholera,  or  other  disorders  in  which  a  peculiar  poison  has  been  at 
work,  and  the  fluid  has  been  morbidly  affected,  and  you  will  be 
sure  to  fail  to  discover  in  it  traces  of  the  presence  of  that  poison, 
of  whose  existence,  nevertheless,  there  can  be  no  doubt.  In  such 
blood  the  quantity  of  water,  fibrine,  corpuscles  or  residue  of  the 
serum  may  vary  more  or  less  from  that  contained  in  the  healthy 
fluid.  The  solidity  of  the  clot  may  differ,3  but  in  no  instance  can 
we  detect  the  specific  materies  rnorli. 

It  is  not  a  little  surprising,  if  not  amusing,  to  find  that  while, 
by  ignoring  the  presence  in  the  atmosphere  of  a  particular  matter 
which,  by  its  poisonous  property,  is  supposed  to  give  rise  to  fever, 

1  Aphorism  583,  p.  202. 

2  See  the  experiments  of  Andral  and  Gavnrret,  and  of  Becquerel  and  Rodier:  see 
also  Bouchat,  Maladies  Contagieuses,  Gaz.  Mod.  18-18;   Simon,  i.  300. 

3  Simon,  i.  288,  298,  325. 


128  PNEUMONIA    AND 

and  to  which  the  name  of  malaria  has  been  applied;  in  other  words, 
while,  by  denying  a  separate  existence  to  febrile  effluvia,  on  the 
ground  that  chemistry  has  not  succeeded  in  detecting  them,  the 
disbelievers  in  that  poison  seem  anxious  to  vindicate  the  character 
of  the  science  for  infallibility,  or  at  least  to  uphold  the  idea  that 
it  has  reached,  on  the  subject  in  question,  its  culminating  point,  and 
that  its  not  having  succeeded  in  attaining  the  object  in  view,  indi 
cates  positively  the  impossibility  of  this  ever  being  effected,  profes 
sional  chemists  of  the  highest  eminence,  so  far  from  carrying  their 
pretensions  that  high,  acknowledge  the  deficiency  of  their  present 
means,  admit  that  their  science  is  yet  in  its  infancy,  and  do  not 
hesitate  to  say  that  the  want  of  success  in  the  detection  of  malarial 
emanations  is  not  to  be  taken  as  an  evidence  of  the  non-existence 
of  these.  The  celebrated  author  of  the  Statique  Chimique,  Bertholet, 
somewhere  says:  "Besides  its  constituent  parts,  the  atmospheric  air 
may  contain  in  solution  different  substances,  which  assume  in  it 
the  elastic  form,  and  of  which  some  are  principles  of  odours ;  but  so 
far  these  emanations  have  eluded  chemical  means,  which  can  destroy 
some,  but  not  detect  them."1  Similar  admissions  are  made  by  Eas- 
pail,2  Muldor,  Van  Gaens,3  and  others ;  but  by  none  more  clearly 
than  Sir  H.  Davy,  who,  while  expressing  the  conviction  that,  by  the 
progress  of  chemistry  and  physiology,  success  will  ultimately  be 
obtained  on  this  point,  says :  "  That  a  specific  matter  of  contagion 
has  not  been  detected  by  chemical  means  in  the  atmosphere  of 
marshes,  does  not  prove  its  non-existence.  We  know  so  little  of 
those  agents  that  affect  the  human  constitution,  that  it  is  of  no  use 
to  reason  on  the  subject."4 

Nature  and  condition  of  fever  localities  lead  to  the  opinion  of  the 
existence  of  malaria. — The  opinion  which  ascribes  autumnal  fevers  to 
the  contamination  of  the  atmosphere  by  poisonous  effluvia,  receives 
not  a  little  support  from  their  very  frequent  association  with  pecu 
liar  characters  and  conditions  of  the  localities  where  they  are  noticed, 
and  from  their  absence  or  cessation  where  those  characters  and  con 
ditions  are  wanting,  or  have  been  removed  by  artificial  or  other 
means.  Whenever  we  encounter  such  localities — characterized  by 
a  geological  formation  of  tertiary  and  cretaceous  secondary  deposit 

i  Vol.  i.  2  Hist.  Nat.  de  la  Santo  et  cle  la  Maladie,  i.  40. 

3  Quoted  by  Harrison,  New  Orleans  Journal,  ii.  582. 

4  Consolation  in  Travel,  Works,  ix.  582. 


AUTUMNAL   FEVERS.  129 

with  argillaceous  and  rich  alluvial  soil  more  or  less  impervious 
to  water ;  or  where,  whatever  be  the  appearance  of  the  soil,  water 
is  found  at  a  very  short  distance  from  the  surface ;  or  where  the 
latter  is  dotted  with  marshy  fields,  and  traversed  "by  sluggish 
streams ;  or  by  swampy,  low,  flat  level  land,  as  along  the  banks  of 
lakes  and  winding  streams;  or  by  level  plains,  ravines,  or  deep 
valleys,  either  dried  or  drying  on  the  surface,  after  having  been 
thoroughly  wet,  and  perchance  encased  between  mountain  eleva 
tions,  covered,  as  in  India,  with,  jungles;  or,  in  the  West  Indies,  with 
impenetrable  mangroves  or  thick  forests,  and  containing  a  large 
amount  of  organic  remains — there  we  may  be  very  certain  to  meet 
with  fever.  "It  is  a  safe  generalization  to  affirm,"  says  Dr.  Drake  (p. 
709),  "  that,  all  other  circumstances  being  equal,  autumnal  fever  pre 
vails  most  where  the  amount  of  organic  matter  is  greatest,  and  least 
where  it  is  least.''  In  localities  thus  characterized,  I  repeat,  we  may 
almost  certainly  count  on  meeting  with  malarial  fever  in  some  one 
or  other  of  its  varied  forms,  after  a  certain  continuance  of  high 
atmospheric  heat.  In  others,  differently  circumstanced,  we  may 
safely  anticipate  an  exemption  from  that  disease.1  The  salt  marshes 
of  Normandy — about  Doll,  for  example;  the  soil  along  the  Medi 
terranean  coast  of  France ;  the  shores  of  the  Adriatic,  of  Greece, 
and  of  Sicily;  those  of  Sardinia,  of  Spain,  of  Crimea;  the  lagunes 
of  Holland,  from  the  Walcheren  to  Groningen;  the  soil  of  Flanders; 
the  Pontine  marshes  of  the  Pontifical  States,  and  the  campagna  in 
the  vicinity  of  Kome;  the  maremme  of  Tuscany,  Lucca,  and  the 
Mantuan;  the  soil  of  the  Bresse,  of  Sologne,  of  Dombes,  of  the 
vicinity  of  Camargue,  Aigues  Mortes,  Marenne,  Brouage,  Eoche- 
fort,  and  other  parts  of  France ;  the  coasts  of  Batavia  and  Mada 
gascar;  the  alluvial  districts  of  the  western  and  eastern  coasts  of 
Africa ;  those  of  Algiers,  and  of  India ;  a  large  portion  of  the  United 
States,  from  the  Delaware  to  the  Mississippi  on  the  Atlantic  coast ; 
along  the  margins  of  the  lakes,  the  Mississippi  Eiver,  and  other 
western  streams;  a  large  surface  in  South  America  and  in  the  West 

1  What  is  termed  peat  boo:,  or  peat  moss,  is  said  not  to  be  productive  of  malaria. 
Many  parts  of  Scotland  and  Ireland,  that  are  occupied  by  large  tracts  of  marsh,  in 
which  peat  moss  abounds,  are  completely  free  from  these  fevers.  The  disease  is  never 
seen  among  the  inhabitants  near  the  country  of  the  Dismal  Swamp,  on  the  frontier  of 
Virginia  and  North  Carolina.  In  them,  the  vegetable  matter  is  subcarbonized,  and 
hence  insusceptible  of  decomposition.  It  is  known  to  possess  peculiar  antiseptic 
qualities,  which  not  only  preserve  trees  and  other  vegetable,  but  animal  substances, 
from  putrefaction.  See  Acton's  Treatise  on  Moss  Earth. 

9 


130  PNEUMONIA    AND 

India  Islands;  along  the  sea-coast,  or  the  borders  of  tropical  streams 
or  lakes ;  the  river  banks  and  low  flat  surfaces  of  Hungary ;  the 
morasses  of  Upland,  the  plains  of  Scanea,  Sudermania,  and  Gothia; 
all  these  localities,  and  many  more  that  might,  if  necessary,  be  men 
tioned,  and  which  are  or  should  be  familiar  to  every  one  who  has 
made  paludal  or  autumnal  fever  the  subject  of  inquiry,  are  in 
point.  They  all  present  some  one  or  more  of  the  characteristics 
pointed  out,  and  are  all,  at  particular  seasons  of  the  year,  and  under 
certain  atmospheric  conditions,  the  seat  of  febrile  affections;  while 
other  places,  sometimes  at  no  great  distance,  but  of  a  different 
geological  formation — less  swampy  or  less  rich  in  organic  materials, 
and  possessing  a  different  soil — are,  though  similarly  circumstanced 
in  other  particulars,  free  from  the  disease.  All  these  facts  serve  to 
illustrate  the  almost  constant  connection  existing,  as  cause  and 
effect,  between  the  kind  of  locality  to  which  I  have  referred  and 
the  disease  in  question. 

Nor  is  it  less  certain  Chat  the  yellow  fever  proper  is  traced  almost 
invariably  to  city  districts  noted  for  filth  and  imperfect  ventilation ; 
to  the  vicinity  of  ships,  docks,  or  wharves;  to  narrow  and  confined 
courts  and  alleys  not  far  from  these;  to  collections  of  substances, 
animal  and  vegetable,  in  a  state  of  decomposition,  &c.  Instances  to 
that  effect  have  been  too  frequently  observed,  and  are  too  well 
authenticated  to  be  denied ;  while  the  connection  between  the 
existence  of  places  of  the  particular  kind  mentioned,  and  the  ap 
pearance  of  that  form  of  fever,  is  too  constantly  found  to  prevail, 
to  be  considered  simply  in  the  light  of  a  coincidence. 

The  danger  of  an  attack  of  fever  increased  in  proportion  to  proximity 
to  such  localities. — If  we  approach  to,  or  remain  some  length  of 
time — occasionally  only  a  few  hours  or  moments — in  those  locali 
ties,  or  in  their  immediate  vicinity,  we  are  stricken  down  with 
fever;  if  we  avoid  them,  we  escape.  The  South  Carolinian  gives 
up  his  plantation  residence  in  summer,  and  removes  to  Charleston 
or  to  the  mountains,  where  he  is  safe  from  the  country  fever.  Let 
him  visit  his  estate  before  the  advent  of  frost,  and  especially  let 
him  sleep  there,  and  he  runs  great  risk  of  an  attack.  In  yellow 
fever  seasons,  strangers  must  leave  or  abstain  from  entering  the 
city;  if  they  venture  into  it,  they  will  in  all  probability  have  the 
disease.  With  us,  in  Philadelphia — as  with  the  residents  of  other 
cities  of  the  Middle  and  neighbouring  States,  and  of  some  parts  of 


AUTUMNAL    FEVERS.  131 

Europe — where  infected  districts  are  of  limited  extent,  the  disease 
is  restricted  to  individuals  who  venture  within  the  bounds  of  these. 
At  a  very  few  paces  from  the  sickly  spot  to  which  they  penetrated, 
and  where  they  doubtless  imbibed  the  seeds  of  the  fever,  people 
move  about,  business  is  transacted  with  perfect  impunity,  and 
everything  often  looks  precisely  as  if  the  city  were  not  the  seat  of 
an  epidemic.  By  avoiding  our  river  banks,  or  our  meadow  or 
marshy  land,  by  remaining  within  the  limits  of  the  city,  or  select 
ing  high  and  dry  situations  in  the  country,  Philadelphians,  like 
Charlestonians,  keep  free  from  chills  and  fever,  or  remittents;  by 
adopting  a  different  course,  they  expose  themselves  to  an  attack. 
On  the  coast  of  the  West  Indies,  and  of  Africa,  as  well,  indeed, 
as  in  this  country  and  Europe,  vessels  remain  healthy  so  long  as 
they  keep  at  a  distance  from  land.1  But  woe  to  them  if,  during  the 
sickly  season,  they  approach  the  shore,  or  enter  the  river  streams. 
The  moment  they  do  that  they  become  liable  to  the  disease.  Lind, 
in  his  work  on  preserving  the  health  of  selimen,  states  that  when 
Commodore  Long's  squadron,  in  the  months  of  July  and  August, 
1744,  lay  off  the  mouth  of  the  Tiber,  it  was  observed  that  one  or 
two  of  the  ships  which  lay  nearest  the  shore  began  to  be  affected 
by  the  pernicious  vapour  from  the  land;  whilst  some  others,  tying 
farther  out  at  sea,  at  but  a  very  small  distance  from  the  former,  had 
not  a  man  sick  at  the  same  time.  (P.  67.)  While  in  the  autumn  of 
1852,  many  British  steamers  and  vessels  of  war  had  the  yellow 
fever  for  going  into  port  at  St.  Thomas.  "Another  of  her  ma 
jesty's  ships,  the  Devastation,  was  at  St.  Thomas,  but  did  not  come 
into  the  harbour,  keeping,  however,  only  about  a  mile  off  the  town, 
and  remained  intact.2 

"  I  have  known."  Sir  Gr.  Blane  remarks,  "  a  hundred  yards  in  a 
road  make  a  difference  in  the  health  of  a  ship  at  anchor,  by  her  be 
ing  under  the  lea  of  marshes  in  one  situation  and  not  in  the  other."3 

1  Lind.  on  Hot  Climates,  138-178-9;  Ibid,  on  Seamen,  78;  Trotter,  i.  456;  Eouppe, 
65 — English  translation,  09;   Rush,  iii.  83;   Bancroft,  171;  Ib.  Sequel,  166;  Clark  on 
Long  Voyages,  i.  124;  Moseley.  57;   IT.  McLean,  26;   Ferguson's  Recollections,  151; 
Gillespie,   20;   Fontana,   12;    Bally,  455;   Pringie,   57,   98;    Chervin's  Letter  to  Dr. 
Monfalcon,  12;  Burnett,  264-274;  Calchvell's  Prize   Diss.   139;  Caldwell's  Essay  on 
Mai.  in  Boston  Journ.   510;  Williams's  Morbid  Poisons,  ii.  446;   Smith,  Edinburgh 
Journ.  xxxv.  49;   Amiel,  Edinburgh  Journ.  xxxv.  264;  Johnson,  Charleston  Journ. 
iv.  160. 

2  Wibleri  and  Harvey  on  Yellow  Fever,  Lancet,  April,  1853,  Am.  ed.  322. 

3  Diseases  of  Seamen,  228. 


132  PNEUMONIA    AND 

It  is  stated  by  masters  of  ships  that  during  the  prevalence  of  the 
late  fever  epidemic  in  Brazil,  though  they  came  direct  from  Europe, 
and  held  communication  with  no  vessel  of  any  kind  on  their  pas 
sage,  the  disease  made  its  appearance  on  board  their  ships  as  soon 
as  they  approached  the  coast,  and  came  within  the  influence  of  the 
land  breeze.  Dr.  Gavin  states  that  when  the  yellow  fever  broke 
out  in  Georgetown,  Demarara,  at  the  end  of  1851,  some  seamen 
arriving  from  Europe  were  attacked  with  the  disease  on  Hearing  the 
coast  and  getting  into  the  muddy  water,  some  days  before  their 
arrival  in  harbour.1 

Lind  states,  in  his  well-known  work  on  Hot  Climates,  that  "many 
persons  escaped  the  yellow  fever  which  prevailed  in  Pensacola,  in 
1765,  by  retiring  to  the 'ships^  which  lay  in  the  harbour."  (179.)  In 
another  place  the  author  remarks:  "When  the  violent  and  fatal 
sickness  raged  at  Cadiz,  in  1764,  it  did  not  extend  its  influence  to 
any  ship  which  lay  at  a  distance  from  the  city."  His  majesty's 
ship,  the  Tweed,  which  was  then  at  anchor  in  Cadiz  Bay,  like  others, 
escaped.  All  the  sick  that  were  sent  on  board  recovered,  no  bad 
symptoms  appearing  in  their  fever,  "  while  a  disease  similar  to  the 
black  vomit  and  the  yellow  fever,  and  equally  mortal,  depopulated 
that  large  city."  (Ib.  178.)  Commodore  Mitchell's  fleet,  which 
anchored  in  the  year  1747,  between  South  Bevel  and  and  Walche- 
ren,  were  perfectly  healthy,  while  the  soldiers,  on  shore,  at  the  same 
time,  and  at  no  great  distance,  were  sorely  afflicted  with  fever."2 

Dr.  Rush  says,  of  the  epidemic  of  1793:  "I  heard  of  some  sea 
faring  people  who  lived  on  board  their  vessels,  who  escaped  the 
disease."3  Dr.  Caldwell  remarks  "that  marsh  malaria  cannot  reach 
the  crew  of  a  ship  lying  at  anchor  but  a  cable  length  from  the 
shore,  where  it  is  generated:"  and  adds:  "Similar  facts  may  be  col 
lected  from  the  history  of  yellow  fever  in  our  own  country.  During 
the  prevalence  of  that  disease  in  Philadelphia,  many  individuals, 
and  several  whole  families,  are  known  to  have  retreated  to  vessels 
lying  not  more  than  from  two  hundred  to  two  hundred  and  fifty 
yards  from  the  wharves,  and  to  have  remained  healthv.  In  New 
York  and  Baltimore  like  instances  have  occurred."1 

Who  is  unacquainted  with  the  fact,  noticed  in  diverse  latitudes, 

1  Second  Report  on  Quarantine,  pp.  14,  1-3;   London,  1852. 

2  Priugle,  llouppe,  and  Lind.  3   (>p.  cit. 
4  Prize  Dissertation,  Boston  Journ.  iii.  p.  -310. 


AUTUMNAL   FEVERS.  133 

that  wliile,  in  vessels  at  a  short  distance  from  infected  localities, 
those  who  remain  on  board  are  exempted  from  fever,  the  boat 
crews,  who,  from  the  nature  of  their  duties,  are  obliged  to  ex 
plore  the  river  banks,  those  who  land  on  business  or  for  recreation, 
are,  especially  if  they  sleep  on  shore,  sooner  or  later  attacked.1 

On  the  other  hand,  vessels  that  are  infected  in  such  localities  lose 
the  fever  (if  they  themselves  do  not  contain  sources  of  infection)  by 
shifting  their  position,  and  anchoring  at  a  distance — sometimes  at  a 
very  short  one — from  the  shore;  or  by  going  to  sea,  and  thereby 
placing  themselves  beyond  the  influence  of  the  land  air.  The 
morbific  agency  (in  Georgetown,  Demerara)  seemed  to  move  in 
shifting  swarms  or  vortices,  hovering  over  a  vessel  here  and  there. 
"Thus,  in  the  beginning  of  1839,  the  .Thomas  King  lay  in  the  divi 
sion  A,  between  Kingston  and  Wighari's  Stellings.  In  one  week 
she  lost  four  hands.  She  unmoored,  and  took  her  station  outside, 
or  to  the  leeward  of  the  Louisa  Baillie;  the  mortality  ceased,  and 
the  health  of  the  crew  became  re-established.  The  Louisa  Baillie. 
that  had  been  right  abreast,  and  sheltered  by  the  Thomas  King  be 
fore  the  unmooring,  and  had  no  deatlt,  although  several  cases  of 
fever,  which  readily  yielded  to  treatment,  became  soon  very  sickly: 
she  lost  four  men,  after  which  she  shifted  her  moorings,  and  the 
mortality  then  ceased  in  her  also.2  These  effects  have  been  observed 
on  frequent  occasions  in  Europe,  in  the  West  Indies,  on  the  coast 
of  Africa,  as  well  as  on  our  western  lakes.3 

I  am  informed  by  Mr.  Martin,  surgeon  of  the  Cananeuch,  a  Gui 
nea  trader  (Dr.  Lincl  states)  that  when  he  was  in  Gambia  River,  in 
company  with  four  other  ships,  the  men  in  one  of  those  ships  were 
daily  taken  ill  of  fevers  and  fluxes,  and  several  of  them  delirious ; 
while  all  the  English  in  the  other  ships  and  in  the  factories  were  in 

1  Eadenock,  Med.  Ohs.  and  Inq.  iv.  157-8;   Trotter,  Med.  Naut.  ii.  80;   Bally,  Ty 
phus  d'Am.  455  ;   Clark  on  Long  Voy.  i.  38-40 ;   Boyle,  75  ;  Rouppe,  pp.  05,  75  ;   Gil- 
lespie,  20;   J.  Hunter,  17;   Valentin,  77;  Galliot,  200;   Bancroft,  172;   Ibid.   Sequel, 
106;  J.  Wilson,  GO;   Fontana,   12;   Blanc  on  Seamen,  92,  892;   Lind.   100,  108,  184, 
102,  195;   Lind.  on  Seamen,  78,  77-8;  J.  Johnson,  03-5,   127,   134;  J.  Wilson,   Stat. 
of  Brit.  W.   I.  Squadron,  85;   Bryson,  151,  &c.  &c. ;   Burnett,   188-225,  208;   Smith, 
Edinburgh  Journ.  xxxv.  18,  47,  50  ;  Alien.  Edinburgh  Monthly  Journ.  Aug.  1847  ;  Bry 
son,  Stat,  Hep.  on  the  Health  of  the  (Brit.)  Navy,  215,  220,  230. 

2  Blair,  80. 

3  Lind.  200;  Ibid,  on  Seamen,  85;   Ferguson's  Becol.  143;  Trotter,  i.  358;   Hunter, 
10;  Keruudren,  18;   H.  McLean,  20;   Eufz.  Report,  by  Cherviu,  CO;   Usher  Parsons's 
Dissertations,  203;  Cooke,  Med.  Recorder,  vii.  451. 


134  PNEUMONIA    AND 

perfect  health ;  but  upon  removing  that  ship  about  half  a  league 
from  her  first  anchorage,  which  was  too  near  some  swamps,  her  men 
became  as  healthy  as  those  in  the  other  ships.1 

Sir  G.  Blanc  remarks :  "  When  ships  watered  at  Rockfort  (Ja 
maica),  they  found  that  if  they  anchored  close  to  the  shore,  so  as 
to  smell  the  land  air,  the  health  of  the  men  was  affected ;  but  upon 
removing  two  cables'  length  no  inconvenience  was  perceived."2 

These  effects  are  not  due  to  heat  alone. — Now,  how  is  all  this  to 
be  accounted  for  ?  Notwithstanding  all  that  has  been  said  to  the 
contrary  by  Towne,3  Poissonniere,4  Madrid,5  llosack,6  Tommasini,7 
Faure,8  Yatable,9  Girardin,10  Bertaud,11  Bourdon,12  Dickinson,13  and 
many  others,  we  may  safely  affirm  that  excessive,  great,  or  long- 
continued  heat,  will  certainty  not  do  so.  Unaided  by  a  more  effi 
cient  morbific  agent  it  has  in  no  instance  been  found  to  occasion  a 
remittent,  an  intermittent,  a  yellow  or  a  pestilential  fever.  It  is 
a  well-ascertained  fact  that  in  many  localities  where  the  heat  is 
intense,  fever  is  seldom  if  at  all  observed,  while  it  prevails  more 
or  less  extensively  in  places  where  the  temperature  is  considerably 
lower.  The  summer  heat  of  the  'southern  portion  of  the  great 
desert  is  very  great ;  but,  as  Dr.  Drake  remarks,  those  who  traverse 
it,  and  keep  at  a  distance  from  its  watercourses,  pass  the  season 
unaffected.  The  same  writer  calls  attention  to  the  fact  that  the 
sandy  banks  of  Pensacola  Bay,  from  its  entrance  up  to  the  town  of 
Pensacola,  suffer  but  little;  while  at  the  head  of  the  bay,  where 
extensive  alluvial  deposits  have  been  made,  the  fever  has  been  so 
constant  and  fatal  as  to  prevent  permanent  settlement.  Yet  the 
temperature  of  both  localities  is  the  same,  for  they  are  but  ten  miles 
apart.  In  some  localities,  as  the  Antilles  generally,  fevers  are  said 

I  Liml  on  Hot  Climates,  180.  2  Diseases  of  Seamen,  178. 

5  A  Treatise  on  the  Diseases  most  frequent  in  the  West  Indies;  and  herein  more 
particularly  of  those  which  occurred  in  Barbadoes.  Loud.  17-0,  11. 

4  Traitc  des  Ficvres  de  St.  Domiugue.     Paris,  1780,  oO. 

5  Ensayo  Analitico  Sobrc  la  Naturaliza,  Causas  y  Cnracion  de  las  Culentnras,  &c. 
ILtbana,  1*21,  pt.  ii.  1.  6  Practice  of  Medicine,  300. 

7  Sulla  Febbre  di  Livorno,  1804;  Sulla  Febbre  Ci.illa  Americana,  \  84,  i.  108. 

8  Fievres  Intermittentcs  et  Continues,  &c.  43,  44. 

9  Ann.  Maritimes,  1S*2S,  830.  10   K.ssai  sur  la  F.  J.  44. 

II  Dissertation  sur  les   Maladies  quo  les  Medecins   de   St.   Dominguc  out  appelte 
Pierre  Jaime,  7. 

12  Considerations  sur  la  Prophylactique  de  la  Firvre  Jaime.  7. 

13  Observations  on  the  Inflam.  Endemic,  &c.  or  Yellow  Fever,  84,  &c. 


AUTUMNAL   FEVEES.  135 

to  be  now  more  rife  than  they  were  formerly,  though  the  tempera 
ture  was  not  lower  then  than  it  is  at  the  present  day.  The  savan 
nahs  or  natural  prairies  of  French  Guiana,  the  arid  deserts  of  Peru, 
and  a  large  portion  of  Spanish  Guiana,  furnish  us  with  examples  of 
the  sort.1  Thermo  metrical  observations  made  in  the  plains  of  Meta, 
situate  on  the  east  side  of  the  oriental  Cordilleras  and  in  the  valley 
of  the  Magnaline  on  the  west  of  the  same  ridge,  exhibit  great  simi 
larity  of  temperature,  yet  the  former  is  remarkable  for  insalubrity, 
while  the  latter  is  free  from  fever.2 

The  range  of  the  thermometer  in  Antigua  and  Barbadoes,  is 
rather  higher  than  in  Dominica,  Tobago,  Jamaica,  or  the  Bahamas: 
yet  we  find  that  the  troops  in  the  latter  stations  suffer  nearly  three 
times  as  much  as  those  in  the  former.3  The  yellow  fever  does  not 
prevail  on  Pigeon  Island,  but  is  of  common  occurrence  in  the  town 
of  Castries,4  though  the  temperature  is  much  the  same  in  both 
places.  While  common  in  some  parts  jjf  the  coast  of  Africa,  the 
same  disease  is  rare  in  Senegal.5  It  is  rare  also  in  Cayenne,  which 
is,  to  say  the  least,  as  hot  as  any  place  within  the  tropics.6  Panuco, 
and  the  plains  of  Coro  and  Cumana,  and  the  coast  of  Coromandel 
and  of  Onixa,  cited  by  Humboldt,7  as  well  as  the  coast  of  Malabar, 
the  deserts  of  Arabia,  and  of  the  Diabakie8  are  rarely  the  seat  of 
malarial  fevers,  especially  of  those  of  a  malignant  character.  The 
same  may  be  said  of  Lima,  Brazil,  Peru,9  the  savannas  or  natural 
prairies  of  French  and  a  large  portion  of  Spanish  Guiana,10  where,  in 
spite  of  excessive  and  long-continued  heat,  this  fever  does  not  exist. 

The  prevalence  of  and  mortality  from  fever  have  also  been  found 
in  the  same  place  far  greater  in  some  seasons  than  in  others — the 
temperature  remaining  nearly  the  same;11  and  it  has  originated  and 
prevailed  in  some  situations — as  well  in  the  West  Indies,  in  Africa, 
in  Europe,  as  in  this  country — nearly  as  often  when  the  range  of 
the  thermometer  was  at  the  minimum  of  tropical  heat  as  at  the 
maximum.12 

1  Leblond,  6,  02-4-5. 

2  Boussingault,  Annnles  do  Cliimic,  Ivii.  153. 

3  Report  on  Mortality  in  British  Army,  101. 

4  Pugnet,  342.  5  Tbevenot,  244. 
6  Bajon  Mem.  sur  Cayenne,  29,  59.                                       7  Volume  i.  02. 

8  Bonneau  et  Sulpici,  llecberches  sur  la  Cont.  de  la  F.  J.  10. 

9  Vicaire,  Annales  Maritimes,  Oct.  1831,  298-9.  I0  Leblond,  0,  02-4-5. 

11  Sickness,  &c.,  in  British  Army,  5,  101  ;  Craigie's  Practice,  i.  224-0. 

12  Report  of  Sickness  of  British  Army,  20  ;  Cartwright's  Recorder,  ix.  220  ;  Blair,  52. 


136  PNEUMONIA    AND 

This  want  of  necessary  connection,  as  cause  and  effect,  between 
high  atmospherical  heat  and  fever — common  autumnal  and  yellow 
— has  been  pointed  out  by  a  large  number  of  writers  on  these 
diseases  as  they  show  themselves  in  various  parts  of  the  globe.1 

Again,  heat  is  greater  in  cities  than  in  the  surrounding  country, 
and  yet  malarial  fevers  are  more  frequently  encountered  in  the 
latter  than  in  the  former.  And  if  the  cause  of  yellow  fever  is  more 
frequently  evolved  in  cities,  it  is  because  it  requires  a  higher  de 
gree  of  temperature.  But  even  this  will  not  serve  to  disprove  my 
position  ;  for,  during  the  existence  of  the  disease,  many  localities  in 
the  close  vicinity  of,  and  just  as  hot  as,  the  part  infected,  remain 
healthy.  Indeed,  in  insalubrious  regions  fevers  are  more  particu 
larly  rife,  not  during  the  hottest  months  of  the  season,  but  some  time 
after,  when  the  average  temperature  has  lowered  in  a  notable  degree. 
Such  has  been  found  to  be  the  case  in  Gibraltar,2  in  France,3  in  this 
city,4  in  Charleston,5  Barcelona,6  the  West  Indies,7  Algeria,8  &c. 
It  may  be  mentioned,  also,  that  fevers  often  cease  long  before  the 
cessation  of  hot  weather — when,  indeed,  the  temperature  has  reached 
its  highest  point.  We  know  that  such  is  the  case  in  relation  to  the 
Egyptian  plague,  and  that  it  has  occurred  also  at  Dantzic,  Toulon, 
and  Stockholm.9  "There  broke  out  a  plague  in  Venice."  says 
Matth.  Yillani,  an  eye-witness  (Lib.  i.  Historiar.),  "in  the  year 
1348,  in  the  month  of  March.  It  was  at  its  height  in  April  and 
May.  It  began  to  decline  in  July,  and  ended  in  August ;  so  that  a 
plague  will  end  in  hot  weather."10  The  occurrence  has  been  noted 
in  reference  to  the  yellow  fever;  and  in  South  America,  this  coun- 

1  Copland,  iii.  151;   Bryson,   197;   Dazille,  Mnlad.  des  Negres,  8,   &c. ;  Ibid,  des 
Pays  Chauds,  4;  J.  Wilson,  00-7;  Boyle,  Ed.  J.  viii.  173;  Warren,  8 ;   Dariste,  32; 
Osgood,  18;  Good,  ii.  108;  Chisholm,  ii.  2(54;  Dalrnas,  38;  Bully,  327;  Gillkrest,  279; 
Musgrave,  Med.  Ch.   Tr.  ix.   121;   Imray,  Ed.  J.   liii.  92;  Chalmers,!.  22;   Lining:, 
ii.  407;   Townsend,  377;   Hosack,  ii.  29;   Chervin,  translation  of  Wilson  on  Fever  of 
Gibraltar,  9;   Sir  J.   Fellowes,  417;   Hunter,  13;   Ferguson,   Med.   Ch.   Tr.  viii.  142; 
Evans,  45;  Davy,  Notes  to  Blair,  52;  Drake,  712-3. 

2  Report  of  Sickness  in  Mediterranean  Station,  65. 

3  Ncpplc,  Fievre  Interin.  135. 

4  Emlen,  N.  A.  Journ.  v.  328 ;  Carey,  7. 

5  Lining,  op.  cit.  ii.  410.  6  Rochoux,  110;  Pariset.  475. 

7  Williamson,  Med.  and  Misccl.  Obs.  on  West  Indies,  i.  210,  211;   Pinckard,  Notes 
on  the  West  Indies,  ii.  485;   11.  Jackson,  Sketches,  9,  10,  11. 

8  Jacquot,  DCS  F.  a  Quinquina,  19;  Haspel,  Maladies  do  1' Algeria,  i.  07. 

9  A  Treatise  on  the  Plague  and  Pestilential  Fever,  10,  11.     Lond.  1751. 

10  Ibid. 


AUTUMNAL    FEVERS.  137 

try,  Europe,  and  elsewhere,  the  same  observation  has  been  made,  so 
far  as  regards  ordinary  fevers.1  To  this  it  may  be  added  that,  in 
localities  where  fevers  have  been  driven  away  through  the  opera 
tion  of  judicious  hygienic  measures,  the  effect  was  not  attended 
with  a  diminution  of  atmospheric  temperature;  that  some  forms  of 
autumnal  periodic  fevers  are  restricted  to  very  circumscribed  locali 
ties,  where  the  heat  is  no  greater  than  in  the  immediate  vicinity;  and 
that  when  it  breaks  out  in  a  ship  and  spares  others  close  by,  or 
when  it  ceases  in  a  vessel  on  the  latter's  shifting  its  position,  we 
cannot  presume  that  a  difference  of  temperature  can  have  had  any 
thing  to  do  with  the  difference  of  the  results  observed. 

The  following  statements,  derived  from  a  report  recently  pub 
lished  by  Mr.  Lorin  Blodget,  who  has  charge  of  the  meteorological 
department  of  the  Smithsonian  Institution  at  Washington,  may  be 
appropriately  placed  here.2 

Few  summers  in  this  country  have  been  characterized  by  greater 
heat  than  the  one  we  have  just  passed  through.  The  excess  has 
prevailed  from  New  Hampshire  to  Savannah  in  Georgia.  The  first 
general  high  temperatures  of  the  season  occurred  on  the  3d  to  the 
5th  of  June,  extending  from  Montreal  to  Florida,  but  sparing  the 
west  generally.  At  the  south,  its  maximum,  from  Chapel  Hill,  N. 
C.,  to  Savannah,  Ga.,  was  92°;  and  at  the  north,  from  Montreal  to 
New  York,  83°.  From  the  14th  to  the  18th,  the  heat  was  excessive 
and  general.  It  commenced  at  the  extreme  west  on  the  12th  and 
13th,  and  did  not  extend  beyond  Camclen,  S.  C.  It  rose  from  90° 
to  94°  in  Ohio,  Kentucky,  and  westward  in  the  same  latitudes. 
From  the  20th  to  the  23d,  there  was  another  general  excess  of  tem 
perature — less  than  the  preceding  in  the  extreme  north,  and  with  a 
considerable  fall  there  on  the  22d ;  but  quite  unusual  and  long-con 
tinued  at  almost  every  other  part  of  the  country.  The  maxima 
varied  from  the  20th  to  the  23d,  and  ranged  from  90°  to  97°.  The 
maximum  of  95°,  was  probably  general  from  New  York  to  Savan 
nah  on  the  23d.  Lastly,  a  most  extraordinary  extreme  of  heat 
occurred  on  the  29th  and  30th.  The  extreme  was  central  in  the 

1  Leblond,  184;  Puguet,  342;  Rush,  iv.  155;   Deveze,   117;    Emlen,  loc.  clt.  329; 
Chisholm,  i.  294  ;   Xott,  Charleston  Journ.  iii.  5  ;   Fenncr,  N.  0.  Journ.  v.  203 ;   Cald- 
well,  Repos.  vii.  149,  153;  Palloni,  33. 

2  On  the  Climatic  Conditions  of  the  Summer  of  1853,  most  directly  affecting  its 
sanatory  character. — New  York  Journal  of  Mcd,  Nov.  1853,  p.  813,  &c. 


138  PNEUMONIA    AND 

latitude  of  Washington,  and  was  limited  at  Savannah,  on  the  south, 
and  Burlington,  Vt,  on  the  north.  It  attained  96°  to  98°  in  Ten 
nessee,  Kentucky,  and  southern  Ohio,  and  77.5°  to  102°  at  Wash 
ington,  and  eastern  Virginia,  and  North  Carolina.  This  is  without 
any  parallel  in  the  records  of  temperature  at  Washington,  and  is 
several  degrees  above  any  recorded  temperature  at  New  Orleans, 
Mobile,  and  Savannah. 

The  temperature  of  July  was  also  high,  and  slightly  above  the 
normal  mean  in  most  parts  of  the  United  States.  The  excessive 
heat  of  the  last  days  of  June  was  prolonged  through  the  1st  and  2d 
of  July  at  94:°  in  Virginia,  at  the  south,  and  the  range  was  generally 
high  in  this  city  and  south,  where  it  was  again  at  92°  to  84°.  The 
temperature  was  at  or  above  90°  after  the  middle  of  the  month  only 
in  the  central  part  of  Georgia  and  Alabama,  and  west  in  the  lati 
tude  of  Washington  to  Texas,  for  two  or  three  days  about  the  20th, 
and  again  about  the  close  of  the  month. 

t^j 

In  August,  a  period  of  general  excessive  heat  occurred,  begin 
ning,  as  usual,  at  the  west,  and  reaching  90°  in  several  places  on 
the  7th  and  8th.  The  maxima  in  Illinois  and  the  adjacent  States 
were  70°  to  90°  from  the  8th  to  the  13th;  in  Ohio  and  Kentucky, 
nearly  the  same ;  and  passing  eastward  a  little  later  through  Penn 
sylvania,  the  district  of  greatest  excess  was  central  at  New  York, 
from  the  12th  to  the  14th.  The  temperature  at  one  place  south 
reached  90°.  Later  in  the  month,  from  the  25th  to  the  31st,  the 
heat  was  unusually  great  in  the  south-west,  Texas,  the  Cherokee 
Territory,  and  Mississippi,  with  an  extraordinary  reverse  in  Iowa 
and  the  adjoining  States. 

Indeed,  the  summer  of  1853  has  been  remarkable  for  its  climatic 
conditions,  and  the  extreme  of  temperature  was  much  more  strik 
ing  than  usual.  Yet,  though  epidemics  of  yellow  fever,  which  re 
quire  a  continuance  of  high  temperature,  prevailed  in  more  places 
than  has  been  the  case  in  this  country  for  the  last  thirty  years, 
many  other  places  that  have  suffered  from  the  disease  on  former 
occasions,  as  Savannah,  Baltimore,  and  New  York,  for  example, 
and  where  the  temperature  was  unusually  high,  and  even  exceeded 
that  of  Philadelphia,  escaped. 

In  the  latter  city,  too,  though  the  mean  temperature  of  the  three 
summer  months  was  76.76,  or  nearly  four  above  the  common 
average,  such  a  heat  could  not  be  considered  as  alone  the  cause  of 
the  disease  from  which  we  suffered;  for  it  has  been  exceeded,  ac- 


AUTUMXAL   FEVERS.  ±69 

cording  to  the  records  of  the  last  sixty -four  years,  on  two  occasions 
—in  1798,  when  the  fever  prevailed,  and  in  1838,  when  the  city 
was  entirely  free  from  it.  It  must  be  added  that,  notwithstanding 
the  unusual  heat  of  the  season,  we  do  not  find  that  ordinary  au 
tumnal  fevers  were  anywhere  more  rife,  or  that  they  extended  over 
a  wider  expanse  of  country  than  usual ;  indeed,  many  localities 
have  remained  healthier  than  in  cooler  seasons. 

Heat,  in  a  word,  may  be,  and  is,  to  a  certain  extent,  requisite  to 
promote  the  formation  of  other  agencies ;  it  is  doubtless  essential 
to  farther  the  evolution  of  the  poison  which  gives  rise  to  the  disease, 
as  everything  connected  with  the  appearance  of  the  latter  proves — 
its  production  in  hot  weather;  its  absence  in  cold,  and  its  disap 
pearance  on  the  accession  of  frost ; — heat  may  act,  besides,  as  an 
exciting  cause ;  but  alone  it  cannot  occasion  the  peculiar  form  of 
fever  under  consideration.  It  requires  materials  to  act  upon,  and 
from  which,  aided  by  other  influences,  it  may  extricate  an  efficient 
cause.  That  high  and  long-continued  heat  may,  and  does  often,  by 
its  action  on  individuals  unaccustomed  to  its  effects,  produce  fever, 
is  doubtless  true,  and  perfectly  well  known  to  all  physicians  ac 
quainted  with  the  complaints  of  hot  climates ;  but  the  disease  thus 
produced  is  different  from  true  malarial  fevers.  More  frequently  it 
gives  rise  to  other  groups  of  morbid  phenomena  more  or  less 
distressing,  violent,  and  dangerous — cerebral  inflammations,  or  con 
gestions,  visceral  inflammations,  inflammatory  angiotenic  fevers; 
but  these  phenomena  are  in  no  way  analogous  to  those  character 
izing  the  regular  and  specific  pyrexiaa  under  consideration. 

Fevers  are  not  the  effects  of  humidity  alone. — Neither  can  we  jus 
tifiably  attribute  the  effects  in  question  to  excess  of  visible  moisture7 
either  of  the  soil  or  of  the  atmosphere,  whether  produced  by  rain, 
or  local  or  accidental  causes ;  or  to  a  high  dew-point,  or  to  fogs 
and  dews  alone,  without  the  co-operation  of  some  other  and  more 
efficient  morbific  agent.  This  view  of  the  etiology  of  autumnal 
fevers  has  been  advocated  by  respectable  authorities,  at  home  and 
abroad.  Dr.  Bell,  of  this  city,  informs  us  that  he  long  had  doubts 
as  to  the  existence  or  agency  of  miasma,  founded  principally  on 
the  circumstance  that  fevers  that  are  usually  treated  as  endemical, 
not  unfrequently  become  epidemical,  and  that  this  extension  of 
such  diseases  is  not  pretended  to  be  explained  by  an  extrication  of 
more  miasma  than  usual,  but  bv  <rreat  irregularities  in  the  seasons, 


110  PNEUMONIA    AND 

and  abnormal  vicissitudes  in  the  weather.  The  perusal  of  G-iannini 
on  Fevers,  gave  him  additional  reasons  for  distrusting  the  fashion 
able  theory — a  result  which  must  appear  strange  to  any  one  who 
has  seriously  examined  the  work.  But  when  he  became  acquainted 
with  the  valuable  experiments  and  observations  of  Dr.  Wells  on 
Dew,  and  "  discovered  that  all  the  pretended  laws  of  miasm  were, 
in  fact,  the  phenomena  of  dew,  which  latter  we  could  accurately 
notice,  while  the  separate  existence  of  the  former,  or  its  independent 
action,  were  never  demonstrated,"  he  could  not  hesitate  to  abandon 
his  belief  in  a  doctrine  not  supported  by  fair  induction  from  ob 
served  facts ;]  thus,  let  it  be  remarked,  arriving,  from  the  same  data, 
at  conclusions  very  different  from  those  which  Dr.  Wells  reached ; 
for  that  distinguished  physician  never  dreamed  of  denying  the 
existence  and  morbific  effects  of  miasm. 

The  opinion  of  the  main  agency  of  humidity  in  the  production 
of  fever  was  also  warmly  supported  in  England  by  Fordyce.  By 
this  distinguished  writer,  whose  Dissertations  on  Fever  are  among 
the  most  valuable  works  on  the  subject  in  our  language,  it  was  ad 
mitted  that  if  water  is  applied  in  a  mass,  "  that  is  to  say,  if  a  man 
immerses  the  whole,  or  any  part  of  his  body  in  water,  of  the  tem 
perature  of  the  atmosphere,  in  which  he  remains  some  time ;  or  if 
he  throws  water  of  such  heat  into  his  stomach,"  he  is  not  found  to 
be  more  frequently  afterwards  affected  with  fever  than  other  indi 
viduals  not  so  exposed ;  but  if  the  air  has  particles  of  water  floating 
in  it,  thus  constituting  mist  or  fog,  or  otherwise  rendering  it  moist, 
and  a  man  has  continued  for  some  time  in  such  an  air,  fever  very 
frequently  follows.  Moisture,  therefore,  must  be  the  cause  of  fever. 
"Some,"  he  remarks,  " have  contended  that  the  application  of  water 
suspended  in  the  atmosphere  in  the  form  of  moisture,  does  not  pro 
duce  fever.  If  those  who  hold  this  doctrine  "  were  to  live  a  year  or 
two  in  Batavia,  they  would  be  convinced,  by  fatal  experience,  that 
men  living  in  a  moist  atmosphere  are  more  frequently  affected  with, 
fever  than  a  dry  one."  "Men,  wearing  any  moist  covering,  have  been 
more  frequently  affected  with  fever  than  those  who  have  worn 
clothes  not  moistened  with  water."  Some  may  escape ;  but  that  is 
no  proof  of  the  harmlessness  of  such  exposure  :  and  "  the  many  ob 
servations  of  men  being  immediately  seized  with  fever,  as  well  as 
other  diseases,  after  being  exposed  to  moisture,  more  frequently 

1  Bell  on  Miasm,  277. 


AUTUMNAL   FEVERS.  141 

than  those  who  have  worn  clothes  free  from  all  moisture  (the  other 
circumstances  being  the  same),  which  have  been  both  recorded  in 
the  annals  of  medicine,  and  have  come  under  the  author's  inspec 
tion,  give  as  full  evidence  that  moist  clothes  are  capable  of  producing 
fever  as  any  that  can  be  generally  procured  with  regard  to  the 
causes  of  diseases." 

"  Moisture  in  the  air,"  Dr.  Fordyce  continues,  "or  of  the  covering 
of  the  body,  produces  more  fevers  the  warmer  the  atmosphere.  But 
moisture  produces  fever  in  all  temperatures.  The  Dutch  have 
endeavoured  to  make  the  country  of  Batavia  resemble  Holland  in 
the  immense  number  of  its  canals.  The  consequent  moisture  of 
the  atmosphere  is  very  great  in  both  places ;  but,  although  fevers 
therefore  frequently  occur  in  Holland,  they 'bear  no  comparison  in 
number  to  those  which  happen  in  Batavia,  where  the  fatality  (owing 
to  the  moisture  and  heat  of  the  climate)  is  so  great  that  it  is  won 
derful  any  person  should  ever  approach  that  settlement,  but  from 
the  absolute  impossibility  of  otherwise  obtaining  water  or  food." 

Fordyce  was  well  aware  that  "  when  the  air  is  moist,  in  conse 
quence  of  water  evaporating  from  a  marshy  country,  or  from  canals 
in  which  the  water  is  stagnating,  or  moving  with  a  very  slow  motion, 
fevers  more  frequently  arise  than  when  the  moisture  proceeds  from 
the  sea,  large  lakes,  or  rivers  confined  within  their  banks,  and  run 
ning  with  a  considerable .  degree  of  rapidity."  But  this,  according 
to  him,  is  no  argument  against  the  correctness  of  his  views ;  for 
instances  may  be  cited  in  which  the  disease  occurred  in  situations 
where  the  decomposition  of  animal  and  vegetable  substances,  such 
as  occurs  in  marshes,  could  not  be  suspected.  Thus,  in  the  war 
which  took  place  in  Flanders  in  the  years  1710  and  1711,  "an 
army  encamped  upon  a  pure  sand,  in  which  water  was  found  in 
digging  less  than  a  foot  deep,  and  occasioned  a  great  moisture  in 
the  air,  exhibited  in  a  few  days  numbers  of  fevers,  although  the 
army  was  perfectly  healthy  before,  and  no  more  fevers  were  pro 
duced  on  shifting  their  ground.  There  are  a  vast  many  other 
instances  of  the  same  thing  having  taken  place.  Besides,  fever  has 
often  arisen  immediately  in  persons  sitting  in  rooms  the  floors  of 
which  had  just  been  moistened  with  pure  water.  Although,  there 
fore,  substances  arising  from  putrefying  animal  or  vegetable  matters, 
in  marshes,  or  other  stagnant  waters,  render  the  vapour  arising  from 
them  the  more  dangerous ;  yet  it  does  not  follow  from  thence  that 
the  particles  of  the  water  forming  the  moisture  of  the  atmosphere, 


142  PNEUMONIA    AND 

may  not  of  themselves  be  the  cause  of  the  disease."1  In  his  Fourth 
Dissertation,  Dr.  Fordyce  reverts  to  the  same  views,  and  says: 
"These  diseases  have  been  produced  in  countries  where  the  water 
was  found  at  only  a  foot  or  two  under  the  surface  of  the  earth, 
whence  the  moisture  has  arisen  and  contaminated  the  air  so  as  to 
occasion^,  these  diseases,  while  the  soil  has  been  perfectly  dry,  and 
there  has  not  been  the  least  appearance  of  putrefaction,  the  country 
being  clear  from  woods.  In  this  case  it  could  be  nothing  but  the 
moisture  that  produced  the  disease.  One  instance  of  this  occurs  in 
the  encampment  of  the  English  army  in  the  war  about  the  year 
17-io,  in  a  sandy  plain  in  Flanders.  Another  in  a  region  of  Peru, 
where  water  is  everywhere  to  be  found  at  about  seventeen  inches 
below  the  surface  of  the  earth,  .though  the  country  itself  is  barren 
for  the  want  of  water,  and  uninhabitable  from  the  number  of  dysen 
teries  and  semi-tertians  which  take  place  in  it."2 

That  fevers  frequently  occur  during  rainy  seasons,  and  are,  in 
deed,  ordinarily  encountered  in  damp  localities,  where  rain  is  com 
mon  and  falls  abundantly ;  where  the  soil,  previously  dry,  has  been 
rendered  wet  by  some  of  the  causes  referred  to,  rain,  freshets,  over 
flows,  &c.;  or  where  the  dew-point  is  high,  and  vesicular  humid 
ity  generally  or  often  noticed,  or  considerable  at  the  time ;  that 
they  often  make  their  appearances  at  the  first  set  in  of  the  rains, 
the  country  prior  to  this  having  been  dry  and  healthy ;  and  that 
hence  a  certain  degree  of  humidity  appears  to  be  necessary  to  the 
development  of  the  disease — the  wetting,  in  contradistinction  to  the 
drying  process,  proving  injurious  to  health  by  exciting  the  fevers  in 
question — are  facts  which  no  one  need  be  told.  It  is  true,  also,  that 
in  many  instances,  if  not  in  all,  long-continued  and  thorough  terres 
trial  humidity,  or  saturation  of  the  soil,  has  been  found  to  precede 
epidemic  manifestations  of  yellow  and  some  other  forms  of  malarial 
fevers;  and,  on  the  other  hand,  that  a  complete  absence  of  such 
humidity,  a  thorough  desiccation  of  the  soil  to  a  great  depth,  as  well 
as  an  excessive  dry  ness  of  the  atmosphere,  are  inimical  to  the  pro 
duction  and  continued  prevalence  of  those  diseases.  Facts  to  that 
effect  have  been  observed  and  recorded  in  this  country,  in  South 
America,  in  the  West  Indies,  in  Africa,  Europe,  and  Asia,  They 
are  true  as  regards  both  ordinary  autumnal  or  periodic  fevers,  and 
malignant  yellow  fever.  The  humidity  of  the  "West  Indies,  of  must 

1  Five  Dissertations  on  Fever,  i.  76,  79.    Am.  ed.  2  Ibid.  Am.  eel.  -)51. 


AUTUMNAL    FEVERS.  143 

parts  of  our  Southern  States  and  of  the  coast  of  Africa,  is  prover 
bial;  and  we  know,  not  only  that  these  are  all  fever  regions,  but 
that  the  outbreak  of  the  disease  coincides  often  with  a  wet  season, 
and  with  the  manifestation  of  increased  moisture. 

The  following  remarks  of  Lind,  relative  to  the  African  coast,  will 
apply  to  many  other  places:  "The  large  rivers  in  the  dry  season 
being  confined  within  narrow  bounds,  leave  a  great  part  of  their 
channels  uncovered,  which,  having  their  moisture  totally  exhaled, 
become  a  solid  hard  crust ;  no  sooner  do  the  rains  fall  than  this  long- 
parched  crust  of  earth  and  clay  gradually  softens,  and  the  ground, 
which  before  had  not  the  least  smell,  begins  to  emit  a  stench,  which 
in  four  or  five  weeks  becomes  exceedingly  noisome.  At  this  time, 
the  sickness  is  generally  most  violent."1 

In  tropical  regions,  the  sickly  or  fever  season  corresponds  with 
that  of  the  rains.  In  the  French  colonies,  it  is  denominated  hiver- 
nage.  The  latter  is  the  period  in  which  the  sun  heats  the  portion 
of  the  zodiac  situated  on  the  side  of  the  equinoxial  line  where  the 
rains  prevail.  The  hivernage  is  consequently  in  reality  the  summer 
of  such  sections  of  tropical  regions  where  it  is  observed.  When 
the  sun  crosses  the  line,  the  rainy  season  necessarily  changes  side ; 
and  with  the  accession  of  wet  weather  we  have  the  advent  of  fever.2 

The  connection  of  humidity  with  fever — the  necessity  of  the 
former  for  the  production  of  the  latter — is  exemplified  by  the  oc 
currences  at  Tampico  in  1836.  The  rains  commence  there  in  July, 
and  are  followed  by  intense  heat.  This  is  the  period  of  yellow 
fever.  In  the  above-mentioned  year  the  rainy  season  commenced 
two  months  later  than  usual,  and  there  was  a  corresponding  delay 
in  the  appearance  of  the  disease.3 

In  Bengal,  the  rainy  season  commences  in  June  and  continues 
until  October;  the  remainder  of  the  year  is  healthy  and  pleasant. 
During  the  rains,  the  rich  and  fertile  country  is  almost  quite  covered 
by  the  overflowing  of  the  Ganges,  and  converted,  as  it  were,  into  a 
large  pool  of  water.  Diseases  rage  among  the  Europeans  in  the 
months  of  July,  August,  September,  and  October,  consequently 
during  the  rainy  or  wet  season.4 

1  Hot  Climates,  54. 

2  Becquerel,  Des  Climats  ct  do  1'Influence  qu'  exerccnt  les  Sols  Boise?,  &c.  124. 

3  Goupille.au,  Bulletin  de  FAcad.  i.  456 ;  Ibid.  iii.  306. 

4  Lind,  Hot  Climates,  91 ;  Shannon,  Practical  Obs.,  &c.  on  Diseases  of  Hot  Climates, 
74  ;  J.  Johnson  on  Tropical  Climates,  59. 


144  PNEUMONIA    AND 

That  the  deleterious  influence  of  the  atmosphere  is  aggravated 
bv  an  undue  degree  of  moisture,  has  been  found  on  more  occasions 
than  one.  The  following  instance  is  derived  from  Dr.  Home's  Dis 
sertation  on  Kemittent  Fever.  This  intelligent  physician,  who 
served  in  Flanders  during  Marlborough's  campaign,  and  was  sur 
geon  to  Colonel  Cope's  dragoons,  observed  that  while  the  cavalry 
were  cantoned,  in  1748,  in  the  unhealthy  ground  about  Bois-le-Duc, 
the  number  of  the  sick  corresponded  with  the  dampness  of  their 
situation  and  of  the  air.  To  settle  the  point,  he  procured  a  good 
hygrometer,  by  which  he  carefully  measured,  daily,  the  degree  of 
moisture  or  dryness  in  the  air ;  and,  upon  comparing  his  tables  with 
the  register  kept  of  the  sick,  he  found  that  the  progress  of  the  dis 
ease  kept  pace,  as  far,  he  says,  as  anything  of  the  kind  can  do,  to 
the  humidity  of  the  air.1  r<  It  is  proper  to  remark  that  the  observa 
tions  of  Dr.  Home  on  this  subject  were  in  the  malarial  districts  of 
the  country,  and  that  th&  greater  degrees  of  moisture,  which  he 
found  to  increase  the  disease,  occurred  in  the  vicinity  of  marshes.2 

But  experience  has  shown  that  this  is  far  from  being  always  the 
case.  Indeed,  we  find  that  the  reverse  often  occurs,  or,  at  least, 
that  humidity,  whether  atmospheric  or  terrestrial — whether  pro 
duced  by  one  or  other  of  the  sources  mentioned,  is  not,  alone  and 
per  se,  sufficient  to  produce  the  effect  in  question.  Fevers  appear 
in  seasons  and  times  of  dryness,  when  the  soil,  on  the  surface  at 
least,  is  parched  for  want  of  rain;  when  there  are  no  fogs,  and  little 
dew.  On  the  other  hand,  they  fail  to  show  themselves  under  cir 
cumstances  of  an  opposite  character,  and  are  often  arrested  in  their 
epidemic  course  by  the  very  means  that  are  supposed  to  be  by 
themselves,  and  without  concurrent  aid  from  other  conditions  of 

1  Dissert.  14;   I  hid.  Metl.  Facts  and  Observations,  61,  G2 ;   Lind  on  Seamen,  72. 

2  "From  the  2(,Hh,  0.  S.,  of  June,  to  the  12th,  0.  S.,  of  July,  we  had  not  one  man 
taken  bad.     During  this  time,  the  air  was  never  very  moist,  though  not  so  dry  as 
what  it  used  to  be  in  my  tent  during  the  d;iy-timc  in  camp.     So  that,  taking  day  and 
night  together,  the  moisture  of  my  room  surpassed  the  moisture  of  my  tent.     On  the 
evening  of   the   12th,  my  hydrometer  fell  very  low,  and   the  air  was   considerably 
damper  than  ever  I  had  yet  seen  it  in  quarters.     From  this  very  night   this  present 
distemper  began  in  our  regiment;  for  that  night  three  were  seized  witli  it.     It  con 
tinued  for  eight  days  damp  weather  ;   and  the  number  of  those  taken  bad  every  day 
increased.      The  ten  days  that  followed  were  drier  ;   during  which  time   not  so  many 
were  taken  bad  as  before.     Two  days  then  followed  of  damp  weather;  in  which   time 
our  number  increased.        Then,   on    the  weather  turning  drier,  the   disease    abated. 
The  same  e<-ual  pace  did  this  disease  keep  afterwards  with  the  moisture  of  the  air." 
(Pp.  Gl,  (12.) 


AUTUMNAL    FEVERS.  145 

atmosphere,  instrumental  in  their  production.  Major  Tullock,  in  his 
excellent  Report  on  the  sickness  of  the  British  troops  in  the  West 
Indies,  after  remarking  that  the  inference  of  the  connection  as 
cause  and  effect  between  humidity  and  disease,  derives  plausibility 
from  various  facts  in  the  history  of  tropical  fevers,  especially  their 
great  prevalence  along  the  sea-coast,  at  the  outlet  of  rivers,  and  in 
the  vicinity  of  swampy  level  ground,  adds  that  this  hypothesis 
seems  at  variance  with  the  facts  noticed :  "  For,  if  the  mortality  of 
the  troops  depended  materially  on  the  influence  of  moisture,  we 
might  expect  it  to  attain  its  maximum  in  those  stations  where  the 
fall  of  rain  was  the  greatest ;  whereas,  the  average  mortality  of  the 
troops  in  Jamaica  is  at  least  double  that  which  prevails  among 
those  in  British  Guiana,  though  the  quantity  of  rain  -which  falls 
in  that  island  is  little  more  than  half  as  great ;  and  in  the  preced 
ing  pages  there  are  adduced  many  instances  in  which  epidemic 
fever  has  broken  out,  and  raged  with  g«reat  violence,  at  a  period 
when  no  rain  had  fallen  for  several  months ;  nay,  in  some  stations 
a  dry,  in  others  a  wet  season,  is  looked  on  as  the  most  unhealthy 
— an  anomaly  not  likely  to  occur  if  excess  of  moisture  was  uni 
formly  an  essential  cause  of  insalubrity."1 

Madeira,  the  Canary  Islands — not  far  from  the  coast  of  Africa — 
the  islands  of  St.  Antonio  and  St.  Nicholas,  are  healthy,  though 
humid ;  while  Fernando  Po,  Princes,  and  St.  Thomas  islands,  riot  far 
from  these,  are,  like  Senegal,  unhealthy.  Barbadoes,  St.  Christopher, 
and  Bermuda,  though  at  no  great  distance  from  fever  countries, 
are  healthy ;  and,  while  St.  Lucia  is  unhealthy  to  a  degree,  Pigeon 
Island,  which  is  not  less  humid  than  the  opposite  coast,  is  free  from 
febrile  diseases.  Dr.  Hollo  calls  attention  to  the  circumstance,  that 
some  of  the  troops  that  landed  in,  1778  at  St.  Lucia,  and  were  en 
camped  at  the  Vigie,  were  there  exposed  to  fatigue,  constant  rain, 
and  changes  from  heat  to  cold,  and  yet  they  were  not  sickly.  They 
were  thence  removed  to  the  windward  of  the  Carenage,  where,  to 
the  former  causes,  were  added  marshy  exhalations.  They  then 
became  subject  to  fevers,  from  which  they  were  once  more  freed  by 
resuming  their  former  position.2 

Ileberden  many  years  since  remarked  that  the  air  is  often  fully 
saturated  with  moisture,  and  could  not  be  more  filled  by  the  vapour 
arising  from  a  chamber  covered  with  water;  and  yet,  he  adds, 

1  P.   101.  2  Diseases  of  the  Army  at  St.  Lucia,  07. 

10 


146  PNEUMONIA   AND 

"  neither  is  any  epidemical  distemper  produced  by  it,  nor  are  those 
remarkably  aggravated  with  which  the  sick  happen  at  the  time  to 
be  afflicted.  The  air  from  rivers  and  from  the  sea,  is  probably 
more  replenished  with  vapours  than  inland  countries  cleared  of  their 
woods,  yet  they  are  generally  healthier."1  Dr.  Ferguson  has  shown, 
from  undeniable  facts,  that  mere  humidity  from  fresh  water  is  not 
productive  of  fever.2  He  remarks  that  water  kept  in  stone  tanks, 
or  anywhere,  so  that  it  can  be  preserved  in  bulk  without  being 
absorbed  by  the  surrounding  soil,  is  not  productive  of  disease. 
One  of  the  healthiest  quarters  in  the  West  Indies,  according  to  that 
able  physician,  is  that  of  the  field  officers  on  Berkshire  Hill,  St. 
Vincent,  the  bedroom  of  which  is  placed  immediately  over  a  deep 
stone  reservoir  of  water.  A  block-house  in  Demerara,  reported  to 
be  one  of  the  healthiest  quarters  there,  is  similarly  situated;  and  it 
is  known  to  all  that  the  fresh  water  laid  in  for  a  ship's  crew,  how 
ever  much  in  contact  with  their  sleeping-places,  produces  nothing 
like  marsh  fever  amongst  them.  Similar  statements  relative  to  the 
innocuousness  of  fresh  water  will  be  found  in  the  works  of  Mc 
Lean,3  Lempriere,4  Bancroft,5  Belcher,6  K.  Jackson,7  Pugnet,8  Dick- 
son,9  Drake,  and  others.10 

In  speaking  of  Fort  Augusta  and  Port  Eoyal,  Jamaica,  Dr.  Hun 
ter  remarks  that  simple  moisture  is  harmless,  "  at  least  as  far  as 
relates  to  the  production  of  fevers,  of  which  the  two  last-mentioned 
places  may  be  given  as  examples,  for  they  are  nearly  surrounded 
with  water  on  all  sides.  It  is  true,"  he  adds,  "  the  air  is  perfectly 
clear,  yet  it  must  be  loaded  with  moisture  in  consequence  of  the 
great  heat  of  the  sun  acting  upon  the  water.  But  the  vapour  arising 
from  water  is  harmless,  even  when  rendered  more  an  object  of  our 
senses,  by  being  condensed  into  .fogs  and  clouds.  The  parish  of 
St.  Thomas  in  the  Vale,  is  every  night  covered  with  a  thick  fog, 

1  Med.  Tr.  by  the  College  of  Physicians  of  London,  ii.  523-4. 

2  Med.  Ch.  Tr.  viii.  129. 

3  An  Inquiry  into  the  Nature  and  Causes  of  the  great  Mortality  among  the  Troops 
at  St.  Domingo.     London,  1797  ;  24-25. 

4  Practical  Observations  on  the  Diseases  of  the  Army  in  Jamaica  in  1792-1797, 
ii.  5,  6. 

5  An  Essay  on  the  Disease  called  Yellow  Fever,  243. 

6  Edinb.  Med.  and  Surg.  Journal,  xxiii.  47. 

7  A  Sketch  of  the  Hist,  and  Cure  of  Febrile  Diseases,  11. 

8  Memoire  sur  les  Fievres  de  Mauvais  Caractere,  342-3. 

9  New  York  Med.  Journal,  Sept.  1841  ;   175. 

10  Diseases  of  the  Valley  of  the  Mississippi,  &c.  i.  010,  711. 


AUTUMNAL   FEVERS.  147 

owing  to  the  rivers  which  pass  through  it  sending  forth  vapours, 
which  in  daytime  are  perfectly  transparent,  but  towards  evening,  by 
the  cool  air  coming  from  the  neighbouring  mountains,  they  are  con 
densed,  and  remain  visible  till  next  day's  sun  disperses  them,  with 
out,  however,  being  at  all  unwholesome."1  Other  facts  lead  to  the 
same  conclusions.  In  an  excellent  report  on  the  epidemics  of 
France  during  the  years  1841-1846,  by  M.  Gaultier  de  Claubry, 
mention  is  made  of  a  small  commune — St.  Jean  de  Losne — situate 
in  a  valley  of  the  Department  of  Cote  d?0r,  along  the  banks  of  the 
Saone,  and  near  the  canal  which  unites  this  river  to  the  Ehine. 
This  commune,  from  its  position,  is  much  exposed  to  fogs,  and 
remarkable  for  its  great  humidity.  Nevertheless,  it  is  usually  free 
from  periodic  diseases.  In  1843,  however,  it  was  visited  by  an 
epidemic  of  intermittent  fever,  which  was  easily  traced  to  other 
causes,  and  could  not  be  due  to  the  hygrometrical  condition  of  the 
atmosphere,  which  at  other  periods  failed  to  produce  that  effect.2 

M.  Madier,  who  practised  at  St.  Andeol*a  small  town  in  France, 
says  of  fogs :  "  We  are  exposed  to  them  at  all  times,  especially 
during  the  spring  and  autumn.  The  fogs,  which  show  themselves 
after  a  few  days  of  dry  weather,  and  when  a  light  rain  has  fallen 
the  day  before,  have  a  very  strong  earthy  smell ;  but  when  they 
appear  after  a  rain  which  has  penetrated  the  soil  to  the  depth  of 
a  few  inches,  they  do  not  emit  any  odour.  I  have  not  noticed  that 
fogs,  in  whatever  season  they  may  prevail,  have  exercised  an  in 
jurious  effect  on  individuals  in  health,  and  given  rise  to  any  par 
ticular  disease."3  Let  it  be  remarked  that  the  country  around  this 
town  is  not  marshy. 

If  fogs  and  heavy  dews  were  of  themselves,  and  without  the 
concurrent  aid  of  other  and  more  efficient  agencies,  the  active  in 
struments  in  the  production  of  fevers,  there  would  be  no  difference 
whence  they  came.  The  effect  would  be  the  same  whether  they 
arose  in  elevated  and  mountainous  regions  or  in  valleys  and  plains. 
Fever  would  be  noticed  in  all  moist  and  foggy  countries — in  the 
"Western  Highlands  or  Cornwall,  more  than  in  Norfolkshire  or 
Lincolnshire,  as  also  in  every  place  where  dews  are  heavy ;  and,  on 
the  other  hand,  localities,  where  fogs  and  dews  are  not  observed, 

1  Obs.  on  the  Dis.  of  the  Army  in  Jamaica,  13,  14. 

2  Mem.  de  1'Acad.  de  Medecine,  xiv.  120. 

3  Mem.  sur  la  Topographia  Med.  du  Bourg  St.  Andeol;  Mem.  de  la  Soc.  Royale, 
v.  78. 


148  PNEUMONIA   AND 

would  not  be  the  seat  of  febrile  complaints.  Now,  we  know  that 
this  is  not  the  case.  These  atmospheric  conditions  are  not  the  pro 
ducts  of  malarial  localities  only.  Dew,  for  example,  will  be  abund 
ant  wherever  vegetation  is  rich,  and  may,  like  fogs,  be  seen  as  well 
on  hill-tops,  where  no  malaria  exists,  as  on  low  ground,  where  it  is 
copiously  evolved ;  or  both  may  prevail  in  a  place  during  healthy 
seasons,  and  be  less  or  not  more  observed  during  sickly  ones.  This 
is  no  fancy  on  my  part ;  for  if  the  reader  inquires  into  the  matter, 
he  will  easily  find  that  everywhere  localities  present  themselves, 
which,  like  those  referred  to  by  Dr.  Hunter,  are  subject  to  fogs  and 
heavy  dews,  and  yet  notwithstanding  are  healthy ;  while,  in  nume 
rous  instances,  fever  has  broken  out  under  meteorological  condi 
tions  which  forbid  the  possibility  of  its  being  referred  to  such 
agencies.  Thus,  the  banks  of  some  streams  in  this  country,  and 
not  a  few  at  a  short  distance,  ijrom  our  city,  though  the  seat  of  heavy 
fogs  and  dews,  are  sel8dm  Visited  by  autumnal  fevers,  not  as  fre 
quently  so,  certainly,  as  other  ki&dred  localities  differently  circum 
stanced.  Such  is  the  case  with  the  upper  part  of  the  Wissahicon, 
where,  notwithstanding  the  fogs  and  dew  observed  in  certain  seasons, 
malarial  diseases  are  not  known.  The  city  of  Charleston  furnishes 
us  with  an  interesting  illustration  of  the  want  of  connection  between 
the  degree  of  evaporation  and  condensation  and  the  production  of 
malarial  fevers.  During  July,  August,  and  September,  of  the  fever 
year  of  1849,  the  evaporation  was  much  higher  than  it  was  in  the 
non-malarial  years  of  a  series  extending  from  1845  to  1852  inclu 
sive,  amounting  to  1,485.  But  in  1852,  which  was  highly  malarial, 
the  evaporation  did  not  exceed  1,454,  while  in  1850  it  was  1,418; 
a  difference  too  trifling  to  justify  us  in  investing  it  with  importance. 
As  to  the  degree  of  condensation,  it  amounted,  in  1849,  to  173 ; 
contrasting  with  what  took  place  during  the  two  non-malarial  years 
of  1850  and  1851,  when  it  was  111  and  81.  On  the  other  hand,  the 
sickly  year  of  1852  gives  us  an  amount  of  only  83 ;  only  two  de 
grees  higher  than  1850,  and  28  lower  than  1851.1 

Were  fogs  and  mists  the  efficient  and  active  cause  of  fever,  we 
might  expect  to  find  the  disease  prevailing  in  other  seasons  besides 
that  in  which  it  almost  exclusively  shows  itself;  and  yet  in  regions 
visited  by  it,  the  humidity  produced  by,  or  connected  with,  the 
thaws  and  fogs  of  the  spring,  and  which,  in  many  instances,  is  as 

1  Hume,  Charleston  Journal,  viii.  67. 


AUTUMNAL   FEVERS.  149 

considerable  as,  if  not  even  more  so  than,  at  the  sickly  period, 
proves  perfectly  innocuous,  heat  being  often  at  the  time  considerable. 

The  waters  of  the  Gulf  Stream  flow  with  great  rapidity  near  the 
banks  of  Newfoundland,  bringing  with  them  a  temperature  of  from 
six  to  twelve  degrees  warmer  than  that  of  the  superincumbent 
atmosphere,  and  of  the  sea  itself  in  that  part  of  the  ocean  according 
to  the  season  of  the  year.  This  superior  heat  in  the  Gulf  Stream, 
as  is  remarked  by  Dr.  Bancroft,  aided  by  its  motion,  produces 
a  copious  evaporation  of  aqueous  particles  from  the  surface,  which 
are  immediately  condensed  by  the  coldness  of  the  air,  so  as  to  pro 
duce  those  fogs  which,  during  summer,  prevail  on  the  Newfound 
land  station,  to  a  greater  excess,  probably,  than  in  any  other  part 
of  the  globe.1  Mr.  Cassini,  as  quoted  by  Bancroft,  states,  in  the 
account  he  has  given  of  his  voyage  to  Newfoundland,  that  "it  is 
difficult  for  one  who  has  never  been  thjere,  to  form  an  idea  of  the 
life  the  fishermen  lead  at  the  Great  BaJak.  "^t  must  be  no  less  power 
ful  a  motive  than  the  thirst  after  gam*which  can  prevail  upon  these 
poor  wretches  to  spend  six  months  between  the  sky  and  water,  in 
a  climate  where  they  are  almost  always  excluded  from  the  sight 
of  the  sun,  and  constantly  breathing  so  thick  a  fog  that  they  can 
hardly  see  from  one  end  of  the  ship  to  the  other."  Yet,  notwith 
standing,  the  men  so  employed  are  remarkably  healthy  and  free 
from  fever.  "The  island,"  says  Major  Tullock,  "has  been  long 
noted  for  the  frequent  and  dense  fogs  which  prevail  along  its  banks, 
and  often  continue  during  a  great  part  of  the  summer.  None  of 
these  agencies,  however,  seem  to  operate  prejudicially  on  the  health 
of  the  inhabitants,  among  whom  the  mortality  is  on  a  lower  scale 
than  on  any  portion  of  the  American  continent.2 

When,  with  these  facts  before  us,  we  bear  in  mind  that  fogs, 
vapours,  and  dews  are  only  injurious — so  far  as  the  production  of 
fever  is  concerned — in  localities  that  are  marshy  or  swampy,  or 
that  possess  a  soil  composed  of  materials  capable  of  furnishing  ma 
larial  exhalations — in  other  words,  in  situations  where  fevers  often 
prevail  without  the  aid  of  such  hygrometrical  phenomena,  or  in 
those  open  to  the  free  admission  and  active  agency  of  winds  pass 
ing,  before  reaching  them,  over  surfaces  of  that  kind,  as  is  the  case 
with  the  smokes  of  the  African  coast ;  we  cannot  resist  the  conclu- 

1  Essay  on  Yellow  Fever,  180,  note. 

2  Report  on  Sickness  of  Troops  in  British  America,  35-6  ;  Lind  on  Hot  Cl.  30-1. 


150  PNEUMONIA    AXD 

sion  that,  when  such  fogs,  vapours,  and  dews  exist  in  sickly  districts, 
they  act  merely  as  predisposing  or  exciting  causes,  and  as  vehicles 
of  the  poisonous  agent,  and  should  not  be  regarded  in  the  light  of 
the  efficient  cause  of  the  disease. 

In  addition,  it  may  be  remarked  that,  in  the  large  majority  of 
places  subject  to  fever,  the  disease  makes  its  appearance  not  at  the 
height  of  the  rainy  season,  when  the  moisture  of  the  atmosphere 
must  be  greatest,  but  at  the  commencement  and  close  of  it,  when 
the  soil  is  moistened  without  being  drenched,  or  after  it  has  become 
somewhat  dried.  Nor  should  we  forget  that  vessels  at  a  short  distance 
from  the  coast  remain  healthy,  and  take  the  fever  by  approaching 
near,  though  the  humidity  in  the  former  situation  was,  if  anything, 
greater  than  in  the  latter ;  that  some  forms  of  fever  are  more  pre 
valent  and  assume  a  more  malignant  character  during  dry  weather, 
and  even  during  droughts  ;  that  in  yellow  fever  regions,  seasons 
marked  by  much  rain  nave  often  proved  the  healthiest;  that,  in 
some  localities,  in  proportion  as  the  humidity  of  the  climate  has 
lessened,  fever  manifestations  have  increased  ;  and  that  the  disease 
is  sometimes  checked  by  heavy  rains. 

We  have  here,  therefore,  the  reverse  of  what  was  said  above  of 
the  injurious  effects  of  the  wetting  process  ;  for  while  the  latter,  by 
its  operations  on  localities  more  or  less  dry  and  parched,  gives  rise 
to  fever,  the  same  disease  is  often  an  attendant  on,  and  a  result  of, 
the  drying  process] — not  making  its  appearance  until  the  surface, 
after  having  been  covered  or  saturated  with  water,  is  becoming, 
through  the  evaporating  agency  of  heat,  to  a  considerable  extent  de 
siccated;  excess  of  dryness  and  excess  of  moisture  being  alike  inim 
ical  to  the  production  of  the  febrile  cause.  In  neither  of  these  two 
processes  can  we  admit,  therefore,  a  monopoly  in  regard  to  the 
power  of  giving  rise  to  that  dire  effect ;  and  the  very  fact  of  two 
influences  of  such  antagonistic  characters  exercising  that  power, 
under  opposite  local  circumstances,  must  naturally  lead  to  the  infer 
ence  that  the  result  in  question  is  obtained,  not  in  virtue  of  any 
morbific  influence  dependent  on  a  wetting  or  drying  operation, 
abstractly  considered,  but  on  the  change  they  each  occasion  in 
the  soil  of  the  locality  thereby  rendered  sickly,  or  in  the  organic 
materials  placed  on  its  surface ; — drying  them  in  the  one  case  when 
too  wet,  and  moistening  them  in  the  other  when  too  dry.  If  we 
admit  this,  we  must  admit  also  that  as  the  effect  is  obtained  in  none 
but  localities  of  the  peculiar  kind  already  mentioned,  and  as  neither 


AUTUMNAL   FEVERS.  151 

the  wetting  nor  the  drying  process  exercises  any  morbific  influence 
of  the  kind  alluded  to,  under  different  conditions  of  soil  or  local 
ity,  that  effect,  when  produced,  must  be  due,  not  to  a  little  more  or 
a  little  less  dryness,  either  of  which,  as  we  have  seen,  may  exist 
in  salubrious  situations,  but  to  the  extrication  from  that  soil  or  the 
materials  scattered  over  it,  of  some  peculiar  agent  which  operates 
as  a  poison  on  individuals  exposed  to  its  influence. 

But  let  this  be  as  it  may  for  the  present,  with  the  above  facts 
before  us,  we  can  better  appreciate  the  pertinency  of  Major  Tul- 
lock's  remarks,  already  referred  to,  that  "  in  some  stations  a  dry,  in 
others  a  wet  season  is  looked  on  as  the  most  unhealthy."  Long 
before  Major  Tullock's  days,  Dazille  had  recorded  the  same  ob 
servation  in  a  passage  strangely  mistranslated  by  Dr.  Rush,  and 
handed  down,  in  all  its  imperfections,  by  several  successive  writers. 
"  It  is  during  dry  weather  that  diseases  pfr eyail  at  Cayenne  ;  on  the 
contrary,  it  is  during  the  rainy  season  tfiat  they  spread  in  St.  Do 
mingo.  The  reason  of  this  difference  is  that  at  Cayenne,  during 
the  period  of  rains,  the  marshes  contain  a  sufficient  quantity  of 
water  to  be  preserved  from  corruption,  and  to  be  renewed  gradually 
by  the  flow  and  ebb  of  the  sea.  When  once  the  rainy  season  is  over, 
the  waters  become  stagnant  and  in  a  state  of  corruption,  and  occa 
sion  by  their  putrefaction  that  of  a  large  quantity  of  insects  and 
animalcules,  the  effluvia  from  which  are  exhaled  in  the  atmosphere, 
thence  pass,  through  means  of  respiration,  into  the  lungs,  and  carry 
into  the  humours  the  germ  of  the  diseases  which  afflict  the  inhabitants 
of  the  vicinity."1  An  accurate  observer  of  modern  times  states,  in 
reference  to  the  malarial  fevers  of  Europe:  "  The  most  unhealthy 
years,  in  humid  districts,  are  those  noted  for  excessive  heat,  or  great 
and  long-continued  dryness ;  while  in  dry  localities,  the  most  sickly 
are  the  rainy  years."2 

The  following  facts  illustrate  the  injurious  effects  of  the  drying 
process: — 

In  India,  during  the  unwholesome  season,  as  stated  by  Bishop 
Heber,  in  the  account  of  his  journey  through  that  country,  all 
living  things  leave  the  pestiferous  region,  and  man  dare  not  venture 
abroad.  "  Yet,  during  the  time  of  the  heaviest  rains,  while  the  water 
falls  in  torrents,  and  the  cloudy  sky  tends  to  prevent  evaporation 
from  the  ground,  the  forest  may  be  passed  with  tolerable  safety.  It 

1  Dazille,  Maladies  des  Xegres,  10.  2  Villerme,  Annales  d'Hygiene,  xi.  347. 


152  PNEUMONIA    AND 

is  in  the  extreme  heat,  and  immediately  after  the  rains  have  ceased, 
in  May,  the  latter  end  of  August,  and  the  early  part  of  September, 
that  it  is  most  deadly."  Of  another  pestiferous  locality  an  intelligent 
writer  remarks:  "The  different  seasons  of  the  year  have  consider 
able  influence  upon  the  unhealthiness  of  Batavia.  On  this  subject 
erroneous  notions  have  been  laid  before  the  public.  The  rainy 
season,  during  the  months  of  January,  February,  March,  and  April, 
has  generally  been  represented  as  the  most  unhealthy.  This  is 
owing  to  an  error  in  observation.  During  the  rainy  season,  the 
rivers  and  canals  are  plentifully  supplied  with  water,  which  flows 
through  them  with  considerable  rapidity ;  most  of  the  lower  marshy 
situations  are  entirely  inundated  with  water,  by  which  the  existing 
putrefaction  is  either  very  much  checked  or  entirely  prevented."  In 
June,  the  marshes  and  canals  begin  to  dry  up,  and  with  this  the 
unhealthiness  commences.  In  July  and  August,  the  dryness  and 
exposure  of  the  latter  are  still  greater,  and  the  disease  is  rife.  "This 
is  the  season  of  death  &nd  destruction."  In  October,  the  dryness, 
etc.,  being  more  excessive,  and  the  materials  of  decomposition  being 
more  thoroughly  destroyed,  the  disease  decreases  and  becomes  less 
malignant.  In  November  and  December  the  effect  is  still  greater.1 
According  to  the  observations  made  by  M.  Don,  chief  civil  engi 
neer  at  Algiers,  as  quoted  by  M.  Becquerel,  from  the  Annuaire 
Meteorologique  de  la  France  (1850),  and  embracing  a  period  of  ten 
years,  from  1887  to  1847,  rain  in  that  country  increases  from 
August  to  December,  and  decreases  from  January  to  July;  the 
maximum  being  in  December  (175.444  millimetres),  and  the  mini 
mum  in  July  (0.150  millimetres).  The  dryness  commences  in  May, 
and  continues  to  the  end  of  September,  sometimes  to  October. 

The  1st  quarter  from  1st  December  to  28th  February,  451.594 
"     2d       "  "      1st  March         to  31st  May,  211.380 

"     3d       "  "      1st  June  to  31st  August,      015.175 

"     4th     "  "      1st  September  to  30th  November,  261.088 

From  this,  we  perceive  that  one  quarter  is  very  wet,  that  an 
other  quarter  is  very  dry,  and  that  these  are  separated  by  two 
quarters  differing  but  little  from  each  other  in  respect  to  the 
amount  of  rain.2 

1  Horsefield,  An  Account  of  a  Voyage  to  Batavia  in  the  Year  1800,  Coxe's  Med. 
Mus.  v.  78. 

2  Becquerel,  Des  Climates,  &c.  174,  175. 


AUTUMNAL    FEVEKS.  153 

Dr.  Haspel,1  whose  observations  were  made  in  the  province  of 
Oran,  divides  the  year  into  four  periods.  The  first  commences  in 
March  and  ends  in  June.  At  this  period  but  little  rain  falls.  The 
second  embraces  July,  August,  and  September.  It  is  characterized 
by  much  dryness.  The  third  period  commences  in  October  and 
ends  during  the  course  of  December.  Kain  now  commences,  and 
falls  in  showers,  which,  with  the  torrents  flowing  from  the  Atlas, 
submerge  the  plains.  The  fourth  period  comprises  the  latter  half 
of  December,  the  whole  of  January  and  February,  and  the  begin 
ning  of  March.  It  is  characterized  by  much  rain,  which  sometimes 
commences  at  the  close  of  November,  and  recurs  at  longer  or 
shorter  intervals  till  the  close  of  the  following  April. 

Now,  on  referring  to  the  highly  interesting  work  just  mentioned, 
and  to  others  on  the  same  subject,  it  will  be  found  that  at  Algiers, 
as  in  other  kindred  climates,  the  spring  months  are  healthy;  while 
the  dry  and  parching  weather  of  July,  August,  and  September  is 
extremely  unhealthy.  Fevers  then  abound,  assume  the  remittent 
type,  and  become  often  pseudo-continued,  and  malignant.  In  the 
third  period,  which,  as  we  have  seen,  is  wet,  malarial  fevers,  though 
becoming  more  severe  and  complicated,  lessen  in  frequency.  Dur 
ing  the  fourth  and  still  wetter  period  they  disappear  nearly  if  not 
completely;  showing  themselves  only  in  individuals  who  have  been 
attacked  in  the  preceding  summer  or  autumn. 

Of  the  years  1845  to  1852  inclusive,  the  last  and  1849  were  the 
only  ones  during  which  the  yellow  fever  prevailed  at  Charleston. 
In  1852,  the  quantity  of  rain  which  fell  during  July  amounted  to 
6.95  inches;  August  furnished  4.21,  and  September  12.27;  mak 
ing  a  total  of  23.43.  In  the  year  1849,  July  gave  6.35,  August 
5.16,  and  September  6.27  ;  total  17.78.  But  while  the  quantity  in 
the  first  of  these  two  sickly  seasons  exceeded  considerably  several 
of  the  healthy  years  of  the  series,  it  was  only  0.68  greater  than 
the  quantity  in  1847,  when  no  fever  prevailed ;  while  the  amount 
that  year  (22.75)  and  in  1845  (19.71)  exceeded  that  in  1849  by 
several  inches.  So  far  as  Charleston  is  concerned,  therefore,  though, 
as  remarked  by  Dr.  Hume,  from  whom  these  facts  are  derived,  the 
yellow  fever  has  never  appeared  in  a  non-pluvial  season,  showing  that 
some  degree  of  humidity  is  required ;  yet  the  facts  mentioned,  and 
many  others  that  could  be  gathered  from  Dr.  Chalmers's  account  of 

1  Maladies  de  1'Alserie,  i.  28. 


154  PNEUMONIA    AND 

the  climate  of  South  Carolina,  pluvial  seasons  are  not  necessarily 
accompanied  by  fever.1  In  1752,  27.45  inches  fell  during  July, 
August,  and  September;  and  yet,  notwithstanding,  the  season  was 
healthy. 

In  Louisiana,  while  some  of  the  most  humid  and  wet  localities 
are  little  affected  by  intermittents,  others,  differently  circumstanced 
in  that  respect,  are  highly  subject  to  the  disease.  Such  is  the  case 
in  East  Feliciana,  and  the  parishes  lying  to  the  east  of  it.  "  These 
parishes  consist  of  high  lands,  which  constitute  a  portion  of  that 
bluff-formation  of  the  south,  and  have  an  elevation  of  from  one 
hundred  to  two  hundred  and  fifty  feet  above  the  level  of  the  Missis 
sippi  Kiver  at  that  point.  The  lands  are  generally  thin,  and  covered 
either  with  open  forests  qf  the  long-leaf  pine,  or  with  those  of  oak, 
beech,  and  other  trees,  intermixed  with  a  growth  of  loblolly  pine, 
and  other  species."  "  In  this  region,  the  climate  is  obviously  drier 
than  in  the  low  landgf  of  the* 'delta,  as  is  shown  by  hygrometrical 
tables,  as  well  as  by  the  fact  that  here  the  Spanish  moss  is  scarcely 
met  with,  while  in  the  low  lands  it  covers  every  tree,  and  the 
growth  of  this  plant  is  a  good  hygrometrical  index.  Notwithstand 
ing  the  favourable  aspect  of  these  regions,  as  respects  health,  the 
inhabitants  are  very  subject  to  ague  and  fever." 

This  connection  of  dryness  with  unhealthiness  had  not  escaped 
the  notice  of  Lord  Bacon,  who  remarks :  "  The  general  opinion  is, 
that  years  hot  and  moist  are  most  pestilent ;  upon  the  superficial 
ground  that  heat  and  moisture  cause  putrefaction.  In  England,  it 
is  found  not  true ;  for  many  times  there  have  been  good  plagues  in 
dry  years.  Whereas,  the  cause  may  be,  for  that  drought,  in  the 
bodies  of  islanders  habituated  to  moist  airs,  doth  exasperate  the 
humours  and  maketh  them  more  apt  to  putrefy  or  inflame ;  besides, 
it  tainteth  the  waters  commonly,  and  maketh  them  less  wholesome. 
And  again,  in  Barbary,  the  plagues  break  up  in  the  summer  when 
the  weather  is  hot  and  dry."3 

The  fever  which  prevailed  at  Copenhagen,  in  1652,  and  is  de 
scribed  by  Bartholin,  began  in  autumn,  after  an  unusually  hot 
and  dry  summer.4  In  1669,  Ley  den  was  visited  by  a  like  fever. 
The  spring  and  beginning  of  summer  were  cold,  but  the  remainder 

1  Hume  on  Causes  of  Yellow  Fever,  Charleston  Journ.  viii.  G4. 

2  Carpenter,  New  Orleans  Journ.  iii.  429. 

3  Bacon,  Nat.  Hist,  Cent.  iv.  Exper.  883. 

4  Hist.  Anatomia,  Bar.  Cent.  ii.  hist.  56. 


AUTUMNAL    FEVERS.  155 

of  summer  and  the  autumn  were  unusually  hot,  with  little  or  no 
rain.1  "  It  is  remarkable,"  says  Pringle,  "  that  pestilential  diseases 
have  frequently  occurred  in  dry  and  hot  summers,  and  agreeably 
to  this,  I  have  observed  that  most  sickly  seasons  in  the  field  have 
been  attended  with  the  greatest  heat  and  the  least  rain."2  Hippoc 
rates  himself  has  left  his  testimony  on  this  subject,  for  he  mentions 
remittent  fevers  as  having  been  common  in  summer  and  autumn, 
and  most  prevalent  when  wet  springs  with  southerly  winds  were 
succeeded  by  hot  and  close  summers.3 

The  example  of  Sicily  is  apposite.  Light  rains  in  autumn  are 
there  unhealthy,  evidently  from  their  moistening  the  earth,  which 
previously  had  been  dried  effectually  and  to  a  great  depth  by  the 
heat  of  summer,  and  thereby  putting  it  in  a  state  capable  of  evolving 
febrific  effluvia.  Whereas,  nothing  is  as  salutary  as  heavy  rains 
about  the  middle  of  September,  which  not  only  mitigate  the  heat, 
but,  by  covering  or  saturating  the  earth,  pu%a  stop  to  the  produc 
tion  of  the  cause  of  fever.4  The  country  is  penetrated  in  several 
directions  by  ridges  of  primitive  hills  of  considerable  height,  and 
apparently  a  continuation  of  the  Apennines.  Between  these  are 
numerous  watercourses,  which  are  dry  in  summer,  and  occasionally 
filled  by  torrents  in  winter.  They  are  denominated  fiumwri,  by  the 
natives,  and  are  used  as  roads  in  the  dry  season.  Many  of  them  are 
extremely  unhealthy  in  the  latter  part  of  summer  and  in  autumn, 
and  infected  by  malaria.  Much  of  this  unhealthiness,  however,  de 
pends  on  the  state  of  the  season.  A  very  dry  season  will,  while 
parching  the  surface  of  the  earth,  put  an  obstacle  to  the  production 
of  the  cause  of  fever,  and  render  the  country  healthy.  The  same 
effect  is  produced  by  a  very  wet  season,  which,  by  saturating  the 
earth  and  completely  filling  up  the  fiumari,  and  covering  their 
sickly  beds,  puts  a  stop  to  the  extrication  of  the  febrific  cause. 
Fever  there  is  rife  only  at  periods  when  the  soil  is  partially  satu 
rated,  and  principally  while  the  drying  process  is  going  on,  or  when, 
after  having  been  parched  and  completely  dried,  it  is  moistened  by 
moderate  rains.  In  situations  where,  from  peculiar  local  circum 
stances,  complete  desiccation  does  not  occur,  and  the  ground  is  only 

1  Silvius  de  la  Boe  Prax.  Med.  Append,  tract,  x.     Oratio  de  affectus  epidemici 
Leidcnsis  causis  naturalibus  dicta.     Leyd.  1670.     12mo. 

2  Dis.  of  the  Army,  81,  part  2,  chap.  ii. 

3  Epidemics,  lib.  iii.  Sect.  3. 

4  Irvine,  Observ.  upon  Diseases  of  Sicily,  2. 


156  PNEUMONIA    AND 

partly  freed  from  water,  as  at  Lentini,  around  which  the  country  is 
marshy,  with  a  considerable  lake  in  the  vicinity,  or,  among  other 
places  in  the  large  foumart  which  bounds  Messina  on  the  northern 
side,  where  the  stream  disappears  in  the  gravel,  and,  percolating 
under  the  surface  to  the  sea,  fresh  water  is  found  at  a  foot  depth, 
fever  prevails  every  year,  and  at  all  seasons.1  In  Sardinia,  too, 
fever  rages  from  June  to  September.  In  some  summers  there  is  a 
want  of  rain  for  four  or. five  months,  and  then  it  is  that  sickness 
exerts  its  utmost  violence.2 

Senegal  is  proverbial  for  the  wide  and  extensive  prevalence  of 
periodic  fevers.  There,  as  in  many  other  places,  the  country  is 
healthy  during  the  height  of  the  rainy  season,  when  the  soil,  like 
that  of  Egypt,  is  nearly  all  covered  over  with  water,  and  the  moist 
ure  of  the  atmosphere  is  necessarily  considerable.  During  the 
drying  process  which  succeeds  to  this  condition  of  things,  and  com 
mences  about  the  mddle  of  September,  the  soil  gradually  becomes 
uncovered,  and  soon  'adorned  with  the  richest  vegetation ;  while  in 
its  moist  state,  it  remains  for  some  time  exposed  to  the  influence  of 
the  burning  sun.  This  is  the  period  of  fevers.  These  extend  far 
and  wide,  and  continue  to  prevail  until,  through  the  effects  of  heat 
and  other  agencies,  the  desiccation  of  the  soil  and  the  dryness  of 
the  atmosphere  become  complete.  As  soon  as  these  results  are 
obtained,  the  country  once  more  becomes  healthy.3 

In  several  of  the  fluvial  basins  within  the  torrid  zone,  or  on  its 
margins,  the  rainy  season  is  the  period  of  health  and  the  dry  season 
that  of  disease.  See  what  takes  place  in  the  district  of  Lower 
Egypt.  There  the  dry  season,  when  the  Nile  is  low,  and  the  coun 
try  is  moistened  solely  by  irrigation,  is  febriferous.  In  May  and 
June  the  majestic  river  begins  to  rise,  and  the  increase  of  the 
water,  and  consequently  of  the  humidity  of  the  soil,  is  hailed  as  the 
sign  of  approaching  salubrity.4 

1  Irvine,  Observ.  upon  Diseases  of  Sicily,  3,  4,  5. 

2  Lind,  31.  3  Thcvenot,  op.  cil.  21,  25,  48. 

4  Prosp.  Alpines,  De  Morb.  JEgjrpt,  lib.  i.  cap.  xiv. ;  Craigie,  Pract.  i.  81 ;  Volney, 
Voy.  en  Egypt,  i.  213;  Macculloch  on  Malaria,  107;  Sir  James  McGrigor,  Sketches,  1. 

The  researches  of  M.  Villerme  on  the  influence  of  marshes  on  the  duration  of  life, l 
have  led  to  interesting  conclusions,  a  summary  of  which  may  be  appropriately  placed 
here.  In  the  eight  most  marshy  departments  of  France  (Ain,  Charente  Infcrieure, 
Card,  Gironde,  Herault,  Bouches  du  llhone,  Var,  and  Vendee),  where  epidemics  of 


An.  d'Hvg.  xi.  340,  &c. 


AUTUMNAL    FEVERS.  157 

We  have  seen  that,  in  Bengal,  the  sickly  is  the  rainy  season,  and 
that  fevers  are  rife  when  the  country  is  wet.  It  appears,  how 
ever,  that  the  moisture  must  keep  within  certain  bounds.  It  is 
remarked  that  the  more  complete  the  inundation,  the  more  healthy 
are  the  inhabitants,  till  the  fall  of  the  waters,  in  November  and 
December,  expose  a  number  of  miry  and  slimy  marshes  to  the 
action  of  a  still  powerful  sun,  when  those  who  are  in  their  neigh 
bourhood  are  sure  to  come  in  for  a  share  of  remittents  and  inter- 
mittents.1  The  same  effects  that  are  noticed  in  Bengalese,  after  the 
waters  begin  to  fall,  take  place  when  the  inundation  has  been  con 
siderable  enough  to  cover  the  country.  "When  the  rains  are  late 

periodic  fever  reign  annually  during  two,  three,  or  four  months,  the  mortality  among 
children  under  four  years  of  age  is  much  greater  in  August,  September,  and  October, 
when  fever  prevails,  than  in  January,  February,  and  March;  while  the  whole  number 
of  deaths  among  individuals,  from  four  years  old  to  one  hundred,  always  attains  its 
maximum  in  winter  ;  in  other  words,  the  influence  of  mar&hel ..""on  young  children  is 
such,  supposing  the  effect  to  be  produced  by  one  cause  only,  that  in  every  thousand 
deaths  of  young  children  which  take  place  in  healthy  districts,  1,546  occur  in  the 
aforesaid  eight  departments.  The  baneful  influence  of  marshes  in  the  above-men 
tioned  classes  will  appear  still  more  striking,  if  we  compare  the  mortality  which 
occurs  in  paludal  districts  during  the  spring  or  the  commencement  of  summer,  when 
it  is  least,  with  that  which  occurs  during  August,  September,  and  October,  when  it  is 
largest ;  for  it  will  be  found  that  for  every  death  noted  in  the  first  period,  we  have  in, 
each  of  the  three  other  mentioned  months,  according  to  the  localities,  two,  three,  four, 
sometimes  five,  and  even  six.  In  the  aforesaid  eight  most  marshy  departments,  the 
number  of  deaths  occasioned  by  paludal  exhalations,  among  very  young  children,  is 
greater  in  September;  while  the  mortality  from  the  same  cause  among  other  indi 
viduals,  reaches  its  maximum  in  October.  But  although,  as  we  have  seen,  the  loss 
among  children  in  those  eight  departments,  considered  together,  is  largest  in  Septem 
ber,  we  find  that,  in  the  departments  of  Ain  and  la  Vendee,  the  least  southern  of  the 
sez-ies,  and  those  in  which  the  desiccation  of  the  marshes  is  effected  at  a  later  period, 
the  most  fatal  month  is  October.  In  the  other  departments,  the  period  of  that 
maximum  is  earlier  in  the  ratio  of  their  southerly  situation,  or  in  proportion  to  the 
earliness  of  the  desiccation  of  the  marshes.  Indeed,  the  period  at  which  these  are 
dry,  as  well  as  that  of  the  prevalence  of  the  disease,  and  of  the  large  mortality  they 
occasion,  advances  in  the  south  of  our  hemisphere,  and  is  retarded  in  the  north. 
When  the  march  of  the  seasons  advances,  or  is  retarded ;  when  the  drying  up  of  the 
marshes  is  longer  in  being  effected,  or  is  accomplished  with  greater  rapidity,  the 
greater  mortality  they  produce  commences  earlier  or  later,  and  continues  iu  the 
autumn  long  after  the  hot  weather,  or  ceases  during  the  continuance  of  them.  M. 
Villerme  properly  remarks  that,  as  the  maximum  of  the  mortality  among  children  in 
the  marshy  departments,  and  an  increased  mortality  at  other  periods  of  life,  constantly 
coincides  with  the  period  of  desiccation,  complete  or  partial,  of  the  marshes,  and  not 
with  that  of  the  greatest  heat,  it  follows  that  this  effect  must  be  ascribed  more  to 
that  desiccation  than  to  a  high  degree  of  temperature. 
1  Johnson  on  Tropical  Climates,  43. 


158  PNEUMONIA    AND 

in  setting  in,  many  people  are  suddenly  cut  off  by  the  intense  heat 
of  the  sun  in  June  and  July.  But  this  is  nothing  compared  to  the 
havoc  produced  by  a  sudden  and  premature  cessation  of  the  rains, 
or  Bursautty,  as  they  are  called.  In  this  last  case,  an  immense  sur 
face  of  slime  and  feculence  is  all  at  once  exposed  to  the  rays  of  a 
vertical  sun."  "  The  consequence  is  that  the  profuse  exhalation  of 
miasmata  spreads  pestilence  in  every  direction."1 

The  air  on  the  flat  country  which  stretches  along  the  eastern  and 
northern  coast  of  the  island  of  Ceylon,  is  very  dry  and  hot,  during 
the  south-west  monsoon.  Showers  rarely  occur  there  during  the 
months  of  May  and  October.  During  the  influence  of  this  mon 
soon,  a  hot  land  wind  blows  from  the  interior  towards  the  eastern 
and  northern  coast  of  the  island.  This  wind  sets  in  about  the 
middle  of  May,  and  blows,  with  but  little  intermission,  till  the  end 
of  August.  In  the  other  months  of  the  year,  there  are  regular  sea 
and  land  breezes.  While  tha  land  wind  prevails,  there  are  but 
rarely  any  sea  breezes.  The  land  wind  often  blows  day  and  night 
for  several  weeks  together,  without  much  abatement ;  it  is  always 
very  dry  and  hot.  Dr.  Marshall,  from  whose  work  on  the  medical 
topography  of  the  interior  of  that  country  I  quote,  states,  in  an 
other  page,  that  the  above  provinces  are  remarkable  for  insalubrity. 
The  late  king  of  Kandy  sometimes  took  advantage  of  the  pestilen 
tial  atmosphere  of  these  districts,  and  transported  thither  the  chiefs 
whom  he  considered  disaffected  to  his  interest.  Few  of  the  inhabi 
tants  escape  the  influence  of  the  fever  during  the  sickly  season 
(pp.  6,  40).  Dr.  John  Davy,  in  like  manner,  informs  us,  that  fevers 
are  rife  in  Ceylon  during  the  season  of  dry  weather  (p.  75).  Dr. 
Kollo  mentions  that  the  greater  part  of  the  regular  remittents  that 
prevailed  at  St.  Lucia  did  so  during  the  rains,  when  the  pools  and 
marshes  were  filled ;  and  that  the  most  dangerous  remittents  ap 
peared  after  their  slimy  surfaces  became  exposed  and  dry.2  Dr. 
Copland  states  that  the  ditch  around  the  ramparts  of  Geneva  was 
once  drained,  and  sickness  prevailed  in  the  vicinity,  but  disap 
peared  when  it  was  again  filled.3 

Dr.  W.  Ferguson,  whose  name  has  become  indissolubly  connected 
with  the  subject  of  miasma,  and  who,  though  erring  in  pushing  his 
notions  as  to  the  necessity  of  a  dried  surface  farther  than  is  war- 

1  Johnson  on  Tropical  Climates,  44.  2  Op,  tit.  69,  70. 

3  Diet.  i.  703,  Endemic  Diseases. 


AUTUMNAL    FEVERS.  159 

ranted  by  a  survey  of  all  the  facts  we  possess,  and  ignoring  the 
agency  of  the  decomposition  of  organic  substances  (to  say  nothing 
of  the  inconsistency  of  denying  in  one  place  this  agency,  and  in 
another  referring  the  fever  which  occurred  on  board  of  the  Regalia, 
to  the  decomposition  of  a  quantity  of  green  wood  stowed  away  in 
the  hold  of  the  vessel) — has  added  considerably  to  the  stock  of  our 
knowledge  in  relation  to  the  sources  of  that  poison,  and  furnished 
many  facts  corroborating  the  views  here  advocated.  The  English 
army  suffered  much  from  endemic  fever,  under  the  remittent  and 
intermittent  forms,  at  Rosendaal  and  Oosterhout,  in  Holland,  in 
1799.  The  summer  had  been  hot  and  dry,  and  the  soil,  which  was 
a  level  plain  of  sand,  presented  a  perfectly  dry  surface.  But  on 
digging,  it  was  universally  found  to  be  percolated  with  water  to 
within  a  few  inches  of  the  surface.  In  1799,  the  army,  under  the 
Duke  of  York,  remained  the  whole  autumn  in  the  most  pestiferous 
portion  of  that  unhealthy  country  without  suffering  in  any  remark 
able  degree  from  fever.  But  the  summer  had  been  wet  and  cold. 
It  rained  constantly,  and  the  whole  country  was  nearly  flooded  with 
water.  In  1810,  the  British  army  at  Walcheren,  on  a  soil  as  similar 
as  possible,  and  not  more  pestiferous,  suffered  considerably  from 
fever.  But  the  soil,  after  having  been  thoroughly  wet,  had  passed 
the  ordeal  of  a  hot  and  dry  summer,  by  which  the  surface  was 
partially  desiccated.  In  Portugal  and  Spain,  during  the  campaign 
of  1809,  Dr.  Ferguson  found  the  hilly  ravines  that  had  lately  been 
watercourses,  but  were  now  dried  up  by  a  continuance  of  several 
weeks  of  very  hot  weather,  to  be  very  unhealthy.  The  same  results 
obtained  during  the  retreat  into  the  plains  of  Estremadura,  along 
the  course  of  the  Guadiana  River  (after  the  battle  of  Talavera). 
The  country,  which  we  may  presume  had  been  wet,  was  then  arid 
and  dry.  The  river  itself,  and  all  the  smaller  streams,  had,  in  fact, 
ceased  to  be  streams,  and  were  no  more  than  lines  of  detached  pools, 
in  the  courses  that  had  formerly  been  rivers.  The  Alentejo  land, 
opposite  Lisbon,  is  dry,  superficially  flat  and  sandy,  and  very  un 
healthy.  So  also  is  Salvatora,  a  large  village  about  a  mile  inland. 
"  The  country  around  is  perfectly  open,  though  very  low,  and 
flooded  with  water  during  the  whole  of  the  rainy  season ;  but  at 
the  time  of  the  periodical  sickness,  it  is  always  most  distressingly 
dry."  "  Cividad  Rodrigo  affords  another  illustration  of  the  same. 
It  is  situated  on  a  rocky  bank  of  the  River  Agueda,  a  remarkably 
clear  stream ;  but  the  approach  to  it,  on  the  side  of  Portugal,  is 


160  PXEUMOXIA    AND 

through  a  bare,  hollow  country,  that  has  been  likened  to  the  dried- 
11  p  bed  of  an  extensive  lake ;  and  upon  more  than  one  occasion, 
when  this  low  land,  after  having  been  flooded  in  the  rainy  season, 
has  become  as  dry  as  a  brick-ground,  with  the  vegetation  utterly 
burned  up,  there  arose  fevers  to  our  troops,  which,  for  malignity  of 
type,  could  only  be  matched  by  those  before  mentioned  on  the 
Guadiana."  Corea,  in  Spanish  Estremadura,  on  the  banks  of  the 
Alagon,  is  highly  unhealthy.  Yet  at  the  time  the  British  troops 
suffered  there,  the  shores  of  the  river  seemed  perfectly  dry,  and 
there  was  not  an  aquatic  weed,  nor  a  speck,  nor  a  line  of  marsh  to 
be  seen  within  miles  of  the  town,  nor  anything  but  dry,  bare,  and 
clear  savanna.  From  the  foregoing  facts,  as  Dr.  Ferguson  remarks, 
it  will  be  seen  that,  in  the  most  unhealthy  parts  of  Spain,  we  may 
in  vain,  towards  the  close  of  the  summer,  look  for  lakes,  marshes, 
ditches,  or  pools.  Spain,  generally  speaking,  is  then,  though  as 
prolific  of  endemic  fever  as  Walcheren,  beyond  all  doubt,  one  of 
the  driest  countries  in  Europe,  and  it  is  not  till  it  has  again  been 
made  one  of  the  wettest,  by  the  periodical  rains,  that  it  can  be  called 
healthy  or  habitable  with  any  degree  of  safety. 

Dr.  Ferguson's  observations  in  the  West  Indies  led  him  to  the 
same  conclusions.  "  It  might  there  be  seen,  that  the  same  deep, 
marshy  country  which  the  rains  made  perfectly  healthy,  as  if  by 
deluging  a  dry  well,  was  speedily  converted,  under  the  drying  pro 
cess  of  a  vertical  sun,  into  a  hotbed  of  pestiferous  miasmata.  Thus, 
in  the  Island  of  St.  Lucia,  the  most  unwholesome  town  of  Castries, 
at  the  bottom  of  the  Carenage,  which  is  altogether  embosomed  in 
a  deep  mangrove  fern,  became  perfectly  healthy  under  the  periodic 
rains ;  while  the  garrison,  on  the  hill  of  Morne  Fortune,  imme 
diately  above  it,  within  half  cannon-shot,  began  to  be  affected  with 
remittent  fever.  The  two  localities  within  this  short  distance 
evidently  changed  places  in  respect  to  health.  The  top  and 
shoulders  of  the  hill  had  been  cleared  of  wood,  and  during  a  con 
tinuance  of  dry  weather,  the  garrison  had  no  source  of  disease 
within  itself;  but  this  was  amply,  though  but  temporarily  supplied, 
as  soon  as  the  rains  had  saturated  the  soil  on  which  it  stood.  Thus, 
an  uncommonly  rainy  season  at  Barbadoes  seldom  failed,  in  that 
perfectly  dry  and  well-cleared  country,  to  induce  for  a  time  general 
sickness ;  while  at  Trinidad,  which  is  almost  all  swampy,  and  the 
centre  of  the  island  may  be  called  a  sea  of  swamp,  where  it  always 
rains  at  least  nine  months  of  the  year — if  it  only  rained  eight,  or 


AUTUMNAL    FEVERS.  161 

if  at  any  time  there  was  a  cessation  of  the  preserving  rains,  the 
worst  kind  of  remittent  fevers  were  sure  to  make  their  appearance. 
General  dryness  of  soil,  however,  is  far  from  being  the  ordinary 
characteristic  of  our  West  India  colonies.  The  swamp  is  too  often 
exposed  to  the  continued  operation  of  a  tropical  sun,  and  its  ap 
proach  to  dryness  is  the  harbinger  of  disease  and  death  to  the 
inhabitants  of  its  vicinity.  On  the  whole,  it  may  truly  be  said, 
that  although  excessive  rains  will  evidently  cause  the  acknowledged 
wholesome  and  unwholesome  soils  to  change  places  for  a  time,  in 
respect  to  health,  a  year  of  stunted  vegetation,  through  dry  seasons, 
and  uncommon  drought,  is  infallibly  a  year  of  pestilence  to  the 
greater  part  of  the  West  India  Colonies."1  In  all  cases,  however, 
previous  saturation  of  the  soil  is  necessary  to  insure  the  effect,  and 
fever  ceases  when  the  exsiccation  is  thorough  and  complete. . 

On  all  these  points,  other  facts,  numerous  and  authentic,  may  be 
found  in  other  writers  on  the  fevers  of  Europe,  of  the  West  Indies, 
of  Mexico,  South  America,  Africa,  and  this  country.2  Indeed,  we  can 
scarcely  open  a  book,  large  or  small,  which  treats  of  the  subject  in 
extenso  or  incidentally,  without  finding  therein  a  repetition  of  the 
same  story — absence  of  fever  during  excess  of  terrestrial  humidity ; 

1  Marsh  Poison ;  see  Notes  and  Recol.  of  a  Professional  Life,  186,  198. 

2  Baglivi,  157-0;  Ramazzini,  Opera  Oninia,  London,  1717;  Rochoux,  11;  Berthe, 
51,  156;  Pariset,   177;   Fellowes,   13,  32,  35;  Boyle,   Ed.  J.  viii.   178;  Beam,  Tr.   of 
Med.  Soc.  Lond.  v.  335;  Report  on  Gibraltar  Fever,  4;  Caillot,  121;  Furlong,  Med.- 
Chir.  Rev.  xxv.  290 ;  Valentin,   87,   89  ;  Lempriere,  i.  26,  31 ;  ii.   47,  48,  49 ;   Des- 
portes,  i.  52,  80,  86,   87;   Ferguson,  Med.-Ch.   Tr.  viii.   130-1;  II.  M'Lean,  25,  72; 
Gillespie,   20,   137;  Johnson,  Trop.  Cl.  362;  Dazille,  Mai.  des  Negres,  10;   Firmin, 
Mai.  de  Surinam,  3,  18;  Bancroft,  200,    314;  Edinb.  J.  Ixiii.  448;   Ibid.,  Ixix.  132; 
Bally,  304,  363 ;  Hillary,  146-7  ;  Jackson,  Outlines,  92 ;  Tullock's  Rep.  64 ;   Gilbert, 
4,  50,  69:  Rufz,  10,  29  ;  Catel,  9  ;  Beguerie,  10;  J.  Clark,  75 ;  Towne,  8;  Leblond,  229; 
Imray,  Ed.  J.  liii.  93;  Ixiv.  331;  Pinkard,  ii.  486;  Henderson,  8;  Arnold,  31,  148, 
174;  Chisholm,  i.  145,  294;  ii.  196;  Humboldt,  765;  Boussingault,  An.  de  Chimie, 
Ivii.  151;  Boteler  (Voy.  of  Disc,  by  Capt.),  i.  137,  155,  156,  356;  Pallas,  109;  Prit- 
chett,  266;  M'Williams,  176;  Boyle,  6,  44,   123;  Brit,  and  For.   Med.-Chir.  Rev.  i. 
382  ;  Jacquot,  14;  Simon's  Kept,  to  Bd.  of  II.  of  Charleston,  6,  10,  18;  Watts,  Med. 
Reg.   of  N.  Y.  278;  Barton,   13;  Revue   Med.,    1840,  322;   Merrill,  Chapman  J.  ix. 
233,  240;  Ibid.  N.  0.  J.  viii.  7  ;  Ibid.  N.  A.  J.  ii.  218;   Rush,  iv.  154;  Chabert,  20; 
Lining,  ii.  407;  Townsend,  263;  Barton's  J.  ii.  22;  Drake,  717;  Gros,  5;  Johnson, 
Charleston  J.  iv.  155;  Hulse,  Maryland  J.,  Jan.   1841,  392;   Thomas,   18,  63,  213; 
Pendleton,  Charleston  J.  vii.  449 ;   Merrill,  Address  on.  Health  and  Mortality  of  Mem 
phis,  Recorder,  i.  88 ;   Bonnet,  Tr.  des  Fievres  In  term.  304 ;   Craigie,  Pract.   of  Med. 
i.  82;  ii.  171;  Villerme,  An.  d'llyg.  xi.  349,  350;  Goupilleau,  Bulletin  de  1'Acad.  i. 
456;  iii.  306;   Sigand,  Du  Climat  et  des  Mai.  du  Brezil,  70-2. 

11 


162  PNEUMONIA    AND 

occurrence  of  the  disease  under  the  influence  of  the  drying  process ; 
again,  absence  of  fever  when  the  exsiccation  of  the  soil  is  complete, 
and  penetrates  to  a  considerable  depth,  and  every  particle  of  moist 
ure  has  been  destroyed;  and  afterward  reappearance  of  disease 
during  the  wetting  period. 

It  must  be  remarked  besides,  and  more  especially  in  reference  to 
the  facts  adduced  by  Dr.  Fordyce,  in  support  of  the  power  of 
moisture  in  producing  fever,  that  most  of  the  instances  in  which 
the  disease  is  supposed  to  have  arisen  from  that  cause,  occurred  in 
situations  more  or  less  characterized  by  a  marshy  condition  of  the 
soil.  Of  all  known  localities,  Batavia  is  the  last  that  should  have 
been  selected  as  illustrative  of  the  febrific  agency  of  simple  moisture. 
"It  is  impossible,"  says  our  countryman,  Dr.  Ilorsefield,  who  was 
well  acquainted  with  the  country,  "  for  the  imagination  to  conceive 
a  situation  more  favourable  to  the  production  of  marsh  miasmata 
than  that  of  Batavia."  "  If  human  industry  and  ingenuity  should 
be  exerted  in  planning  and  constructing  a  laboratory  for  the  pro 
duction  of  pestilential  vapours,  a  situation  exactly  resembling  that 
of  Batavia  and  its  environs  would  be  the  result."1  The  same  may 
be  said  of  many  other  fever  districts  where  moisture  is  sufficiently 
considerable  to  be  made  the  subject  of  notice;  whenever  the  disease 
shows  itself  in  localities  which,  though  not  containing  marshes  pro 
perly  speaking,  are  in  that  condition,  we  may  be  sure  to  find  the 
soil  presenting  these  peculiarities,  which  elsewhere  are  associated 
with  the  advent  of  fever,  and  act  injuriously  without  the  necessary 
coexistence  of  a  notable  amount  of  moisture.  Here,  consequently, 
the  latter  cannot  be  held  up  as  the  efficient  morbific  agent.  It  may 
be  added  that  the  instances  mentioned  by  Dr.  Fordyce,  relating  to  a 
soil  of  pure  sand,  in  which  water  was  found  in  digging  less  than  a 
foot  deep,  and  occasioned  a  great  moisture  in  the  air,  whence  arose 
numbers  of  fevers ;  in  which  the  soil  while  giving  passage  to  the 
excess  of  moisture  adverted  to  remained  perfectly  dry,  and  in  which 
there  did  not  exist  the  least  portion  of  organic  matter  susceptible 
of  decomposition,  may  be  regarded  as  of  a  very  questionable  cha 
racter,  none  of  them  being  mentioned  on  the  authority  of  any  re 
sponsible  writer,  and  some  conflicting  in  the  most  positive  manner 
with  well-ascertained  facts.2 

1  American  Med.  Museum,  i.  77. 

2  To  Mr.  Blodget,  to  whose  Report  on  the  Condition  of  the  Summer  of  1853,  refer- 


AUTUMNAL    FEVERS.  163 

A  IdgJi  dew-point  not  sufficient  to  account  for  the  occurrence  of  fever. 
— For  more  reasons  than  one,  objection  may  be  made  to  much 

ence  has  already  been  made,  we  are  indebted  for  the  following  statements  relative  to 
the  hygrometrical  state  of  the  atmosphere. 

The  heats  of  June,  in  the  summer  of  1853,  were  remarkably  dry.  The  fraction  of 
saturation  was  at  a  mean  of  about  50  in  the  north-east,  and  but  40  to  45  in  the  inte 
rior ;  and  in  Texas,  during  the  hot  days,  from  the  14th  to  the  17th,  though  much  higher 
at  Pensacola  and  the  extreme  south,  where  the  heat  was  not  so  great  from  the  20tli 
to  the  23d ;  the  rate  was  about  the  same  in  the  districts  of  excessive  heat.  On  the 
29th  and  30th,  the  percentage  was  but  35  to  40  in  the  narrow  district  through  Ten 
nessee,  Kentucky,  and  Virginia,  which  marked  100  as  the  maximum  of  temperature. 

The  first  two  days  of  July  were  a  continuation  of  the  condition  of  the  last  of  June. 
The  remainder  of  the  month  was  not  unusual  in  its  hygrometric  character  gene 
rally,  though  at  New  Orleans  the  evidences  of  high  saturation  are  given  in  the  profuse 
and  constant  rains  of  the  middle  of  the  day,  preceded  by  a  hot  and  oppressive  morn 
ing.  The  great  heat  of  August  was  most  remarkable  in  its  hygrometric  condition,  also, 
and  universally  attended  with  a  high  fraction  of  saturation  ;  at  Washington,  it  was  50 
to  GO ;  and  at  New  York,  where,  whatever  may  have  been  the  sickness  and  mortality, 
they  did  not  arise  from  malarial  fevers,  and  where  no  yellow  fever  occurred,  the  fraction 
of  saturation  was  near  70  per  cent,  at  2  P.  M.,  and  almost  at  saturation  morning  and 
evening. 

Kains  in  August  were  excessive. 

The  temperature  of  evaporation  at  New  York  in  August  was  from  80  to  84,  being 
higher  than  the  maximum  temperature  of  evaporation  at  New  Orleans  at  any  time  in 
1852,  by  two  degrees  ;  at  the  latter  place,  it  reached  82  but  once  in  that  year ;  with 
the  exception  of  New  Orleans  and  New  York,  at  this  limited  period,  the  heats  of  the 
summer,  though  extreme,  have  been  attended  with  a  low  humidity. 

In  June,  the  amount  of  rain  was  much  less  than  usual  generally ;  in  July,  it  was 
particularly  large  at  Philadelphia,  and  southward  to  Florida,  where  it  was  11°. 5 
inches.  In  Alabama,  and  at  New  Orleans,  the  amount  was  nearly  as  great,  and  in 
Iowa  and  Wisconsin,  it  was  again  large — from  6  to  8  inches.  In  some  places,  there 
were  severe  droughts,  as  in  eastern  Ohio,  western  Pennsylvania,  arid  New  York.  In 
August,  the  rains  were  excessive  from  the  lower  part  of  New  Hampshire  to  northern 
New  Jersey  ;  at  Bloomfield,  New  Jersey,  and  New  York,  the  amount  falling  was  12 
inches.  From  Baltimore  to  Savannah,  also,  the  amount  was  large,  being  from  5  to 
6.5  inches,  .and  about  1 J  inches  more  than  usual,  the  amount  being  about  3.5  inches. 
The  last  days  of  July,  and  the  first  days  of  August,  gave  an  excessive  precipitation 
in  eastern  Pennsylvania  and  New  York,  New  Jersey,  etc.  These  flooding  rains,  which 
gave  in  some  instances  4  to  8  inches  in  depth  of  water  in  a  single  storm,  of  a  few 
hours,  attended  very  warm  weather,  and  immediately  preceded  the  heats  of  the  12th  to 
the  14th  of  August.  These  were  also  followed  by  profuse  rains,  and  the  whole  period 
from  the  25th  of  July  to  the  15th  of  August  seemed  a  substitution  of  a  tropical 
climate  for  the  usually  elastic  one,  in  the  space  of  country  referred  to. — New  York 
Journal  of  Medicine,  November,  1853. 

Now  it  must  be  remarked  that  the  hygrometrical  conditions  here  referred  to,  ex 
tended  over  a  large  surface  of  country,  and  that  while  some  localities  suffered  severely 
from  malarial  fevers,  of  various  grades  and  types,  others  similarly  circumstanced  in 
point  of  humidity,  evaporation,  and  rain,  escaped  unscathed.  To  this  agent,  therefore, 
we  cannot  look  for  the  efficient  cause  of  the  disease,  even  when  it  is  combined  with 
high  atmospheric  heat. 


164  PNEUMONIA    AND 

of  the  theory  set  forth  by  our  countryman,  Dr.  C.  A.  Lee,  who, 
without  discountenancing  or  disproving  the  existence  of  an  aerial, 
intangible  poison,  looks  for  the  main  and  most  efficient  cause  of 
fever  not,  as  some  have  done,  in  an  excess  of  visible  humidity  alone, 
but  principally  in  a  high  dew-point,  however  produced  (60  degrees 
at  least),  which,  as  he  thinks,  acts  injuriously  in  some  measure,  by 
checking  the  elimination  of  that  poison  from  the  system,  and 
thereby  giving  it  efficiency,  but  chiefly  (and,  as  we  may  presume, 
exclusively  in  cases  in  which  the  poison  does  not  exist,  supposing 
the  occurrence  possible,  which  Dr.  L.  does  not  say),  by  interrupting, 
to  a  greater  or  less  extent,  the  healthy  function  of  the  lungs  and 
skin,  preventing  a  perfect  decarbonization  of,  and  a  sufficient  supply 
of  oxygen  to,  the  blood — carrying  off  the  vitreous  electricity  which 
acts  as  a  vital  stimulus,  and,  as  a  consequence,  increasing  the  secre 
tion  of  bile.1  Still  less  disposed  must  we  be  to  give  our  sanction 
to  the  views  suggested,  and  so  ingeniously  supported  by  Mr.  T. 
Hopkins,  of  Manchester,  who  seems  to  ignore  malaria  altogether, 
and  attempts  to  identify  it  and  a  high  dew-point,  accounting  for  the 
production  of  fevers  solely  by  the  check  thereby  given  to  evapora 
tion  from  the  surface  of  the  body.2 

That  a  high  dew-point  has  a  tendency  to  produce  injurious  effects 
on  the  system;  that  it  is  often  found  to  exist  in  unhealthy  localities, 
or  during  pestilential  times ;  and  that  it  must  assist  somewhat  in  the 
development  of  autumnal  and  periodic  fevers,  are  facts  which  no 
one  will  question.  But  that  it  plays  the  all-important  part  in  the 
causation  of  those  diseases  attributed  to  it  by  Dr.  Lee,  and  particu 
larly  by  Mr.  Hopkins,  is  far  from  being  demonstrated.  Were  the  be 
lief  correct,  we  should  expect  to  find  that  a  high  dew-point — reach 
ing  to  at  least  60  degrees — is  always  attended  with  the  occurrence  of 
malarial  fever  in  one  or  other  of  its  various  forms ;  that  countries 
or  seasons  in  which  the  dew-point  is  high,  are  necessarily  insalubri 
ous;  that  this  condition  is  proportioned  to  the  elevation  of  the  dew- 
point;  and  that,  on  the  contrary,  localities  in  which  the  degree  is  low, 
are  as  necessarily  healthy.  Now  let  us  inquire  how  far  facts  will 
bear  us  out  on  these  points.  We  have  seen  that  fevers,  even  of  a 

1  Forry,  Climate  of  the  U.  S.  112,   113.     In  a  note,  appended  by  Dr.  Lee  to  the 
article  Intermittent  Fever,  of  Copland's  Medical  Dictionary,  he  is  quite  orthodox  on 
the  subject  of  Malaria,  the  existence  and  morbific  agency  of  which  he  fully  admits. 
Not  one  word  is  there  said  about  the  dew-point. 

2  Loud,  and  Edinb.  Phil.  Mag.  3d  S.  No.  80,  Feb.  1839;  An.  d'llygiene,  25. 


AUTUMNAL   FEVERS.  165 

severe  and  malignant  character,  have  not  urifrequently  broken  out, 
and  spread  extensively,  in  places  where  but  little  visible  humidity 
existed ;  where  the  soil  was  arid,  dry,  and  cracked,  and  everything 
upon  it  was  parched  in  consequence  of  long-continued  and  severe 
drought;  where  the  absence  of  rain  was  not  compensated  by  fogs 
and  dews,  and  where,  as  a  natural  result,  the  dew-point  was  found, 
or  might  be  inferred,  not  to  have  reached  very  high.  We  have 
seen,  on  the  other  hand,  that  the  same  or  other  places,  have  re 
mained  exempt  from  those  diseases,  under  hygrometrical  condi 
tions  of  an  opposite  character,  combined  with  a  degree  of  heat  well 
calculated  to  promote  an  excess  of  atmospheric  moisture,  visible 
and  invisible ;  and  when,  from  these  circumstances,  the  dew-point, 
if  not  positively  ascertained  to  have  been  high,  may,  with  perfect 
propriety  be  supposed,  in  the  absence  of  direct  observation,  to  have 
risen  considerably.  It  may  be  remarked,  also,  that  in  places  sub 
ject  to  occasional  visitations  of  autumnal  fever  of  various  grades  of 
intensity,  sickly  seasons  are  not  necessarily  characterized  by  a  higher 
dew-point  than  the  corresponding  periods  of  other  years  in  which 
the  disease  does  not  make  its  appearance. 

In  Demerara,  the  height  of  the  dew-point  in  ordinarjr  seasons  differs 
but  slightly  from  that  to  which  it  reached  during  the  prevalence  of 
the  fever  of  1837-1845.  In  18-43,  the  mean  degree  was  73.8,  vary 
ing  from  72.  (Feb.)  to  74.9  (July,  Aug.,  Nov.)  In  1844,  the  average 
height  was  75.1,  with  a  variation  of  from  73.3  (Dec.)  to  76.0  (May). 
In  1845,  eight  months  give  us  a  mean  of  74.6 — from  73.0  (Jan.)  to 
76.0  (April),  while,  in  1846,  the  year  after  the  cessation  of  the  dis 
ease,  the  mean  dew-point  was  74.4,  with  a  variation  of  from  70.8 
(Feb.)  to  7-6.2  (May  and  June).1 

The  following  table  of  the  dew-points  during  the  months  of  June, 
July,  August,  September,  October,  and  November,  from  1845  to 
1851,  and  July,  August,  and  September,  1852  inclusive,  at  Charles 
ton,  S.  C.,  will  show  to  those  who  are  aware  that  the  yellow  fever 
prevailed  there  during  only  two  of  those  years  (1849  and  1852), 
that  the  difference  in  regard  to  the  saturation  of  the  atmosphere 
during  sickly  and  healthful  seasons  is  but  trifling,  and  cannot  alone 
account  for  the  production  or  absence  of  the  disease ;  and,  indeed, 
that  the  results  obtained  are  very  different  from  those  that  might 
have  been  expected  did  a  high  dew-point  and  fever  stand  in  the 
relation  of  cause  and  effect.2 

1  Blair,  op.  cit.  120.  2  Hume,  Charleston  Journal,  v.  10 ;  viii.  67. 


166  PNEUMONIA    AND 


June. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

1845 

69.46 

72,77 

71.96 

66.00 

54.61 

41.00 

1846 

70.83 

72.82 

75.64 

70.66 

59.22 

50.46 

1847 

71.74 

73.39 

74.23 

68.20 

58.67 

53.53 

1848 

70.26 

73.00 

72.09 

66.26 

58.74 

44.80 

1849 

73.46 

70.77 

72.71 

66.00 

60.93 

53.13 

1850 

67.86 

75.03 

74.93 

69.70 

55.00 

50.86 

1851 

70.73 

74.38 

74.67 

65.13 

57.41 

48.23 

1852 

73.20 

68.77 

68. 

Thus  the  average  dew-point  in  June  and  October  of  the  sickly 
year  of  1849,  was  higher  than  in  the  corresponding  months  of  any 
year  of  the  series ;  but  when  we  examine  the  results  obtained  in. 
the  other  months,  matters  are  found  to  take  a  different  turn.  For 
while  in  July,  1849,  the  average  was  70.77,  and  in  1852,  73.20,  we 
have  a  higher  point  than  in  the  former  in  each  of  the  other  years 
of  the  series,  and  a  higher  one  than  in  1852,  in  the  same  month  of 
1847,  1850,  and  1851.  The  average  in  August,  1846,  1847,  1850, 
and  1851,  was  higher  than  in  1849,  and  higher  than  in  1852  in 
every  year  of  the  series.  September  in  1846,  1847,  1848,  and  1850, 
gave  a  higher  point  than  in  1849,  while  the  amount  in  1852  was 
exceeded  by  that  in  1846,  1847,  and  1850. 

In  New  Orleans,  where  the  average  annual  dew-point,  calculated 
on  a  basis  of  eight  years,  was  found  to  be  63.56  (observed  at  12 
o'clock),  June  being  73.95;  July,  75.42;  August,  75.59;  September, 
73.63 ;  October,  62.73  ;  November,  54.27 ;  the  year  1849,  during 
which  both  the  yellow  fever  and  cholera  prevailed  extensively, 
presents  an  average  for  the  twelve  months  of  63.71  :  June,  74.43 ; 
July,  75.53;  August,  76.75;  September,  73.78;  October,  61.16; 
November,  57.71.1  Indeed,  the  physicians  of  Louisiana  have  had 
frequent  opportunities  to  observe  the  dew-point  for  months  together 
only  a  few  degrees  below  the  atmospheric  temperature,  without, 
however,  suffering  from  any  extraordinary  prevalence  of  intermit- 
tents.2 

The  above  statements  show,  that  the  mean  dew-point  of  the 
summer  in  Charleston  and  New  Orleans,  is  several  degrees  above 
that  of  the  autumnal  season,  when  fevers  are  more  apt  to  be  pre 
valent.  In  the  latter  city,  the  excess  amounted  to  near  nine 
degrees.  In  Charleston,  the  difference  between  the  mean  dew-point 

1  Southern  Mecl.  Repts.  i.  100  ;  ii.  148.  2  Carpenter,  N.  0.  J.  iii.  428. 


AUTUMNAL   FEVERS.  167 

of  the  three  summer  months  of  the  seven  years  specified,  and  that 
of  the  three  following  months,  reached  above  fourteen  degrees. 
Dr.  Gardner,  in  his  essay  on  the  dew-point,  states  the  excess,  in  the 
United  States  generally,  to  be  upwards  of  fifteen  degrees.  It  is 
evident,  also,  from  facts  mentioned  already,  and  from  many  others 
that  might,  if  necessary,  be  added,  that  in  all  parts  of  this  and  other 
countries — in  localities  frequently  or  occasionally  visited  by  yellow 
or  other  forms  of  malarial,  fever — a  dew-point  of  sixty  or  more 
degrees  is  often  experienced  months  together  without  ill  health, 
although  the  temperature  be  such  as  to  promote  the  production  of 
disease.  On  the  other  hand,  as  Dr.  Gardner  properly  remarks,  the 
fens  of  Lincolnshire,  Walcheren,  the  marshes  of  Holland,  are  pesti 
ferous  with  a  dew-point  of  less  than  fifty  degrees.1 

From  these  circumstances,  viewed  in  connection  with  the  fact  so 
often  referred  to,  that  fevers  occur  in  .ships  and  circumscribed 
localities,  while  other  ships  and  localities  in  the  immediate  vicinity, 
and  placed  under  like  meteorological  influences,  remain  exempt ; 
that  the  alleged  effects  are  not  found  to  be  produced  by  a  saturated 
atmosphere  in  the  higher  latitudes;  that  seamen  at  sea  are  exposed 
with  perfect  impunity  to  an  atmosphere  saturated  with  moisture,  and 
are  attacked  only  when  they  land,  indicate  plainly  the  impropriety 
of  attaching  too  much  weight  to  the  hypothesis  in  question,  and 
must  debar  us  from  the  possibility  of  connecting,  as  efficient  cause 
and  effect,  a  high  dew-point  and  malarial  fevers  of  various  grades. 
The  impropriety  of  the  belief  is  farther  proved  by  circumstances 
which  Dr.  Gardner  appears  to  have  established,  i.  e.  that  the  de 
tention  of  the  insensible  vapour  from  the  lungs  or 'the  skin,  by  a 
high  point,  is  much  less  considerable  than  it  is  represented  by  those 
who  have  urged  the  theory ;  that  the  dew-point  in  insalubrious 
places  is  often  much  lower  than  is  thought,  and  that  a  high  point 
does  not  arrest  the  separation  of  carbonic  acid  and  the  other  con 
stituents  of  sweat.  Let  us  examine  the  effects  produced  as  we  may, 
and  concede  to  a  high  dew-point  what  extent  of  agency  soever  we 
may  think  to  be  warranted  by  the  nature  of  the  facts  observed,  as 
well  as  by  the  well-known  influence  of  atmospheric  moisture,  we 
arrive  always  at  the  conclusion  that  something  more  is  necessary 
to  enable  us  to  account  for  the  development  of  fever;  that,  by  itself, 
a  high  dew-point  will  not  occasion  the  disease ;  that,  therefore,  its 

1  American  Journal,  ii.  N.  S.  107. 


168  PNEUMONIA    AND 

agency  is  of  a  secondary  character,  and  consists,  perhaps,  as  Dr.  Lee 
supposes,  in  checking  the  elimination  of  the  febrific  poison,  but  more 
surely  in  predisposing  the  system  to  the  action  of  the  true  efficient 
cause,  by  hindering  a  natural  escape  from  the  blood  of  those  materials 
which  constitute  the  liability  to  the  disease,  or  maintaining  them  in 
a  condition  favourable  to  the  morbid  change ;  as,  also,  like  visible 
humidity,  in  promoting,  when  aided  by  other  influences,  those  re 
actions,  between  the  remains  of  organic  and  inorganic  matters  on 
which  the  evolution  of  the  morbific  agent  depends. 

Heat  and  humidity  combined  not  the  efficient  cause  of  fever. — From 
the  foregoing  facts  and  considerations,  we  may  conclude  that  neither 
heat  nor  moisture,  when  acting  separately,  can  be  productive  of 
autumnal  and  kindred  fevers.  Equally  objectionable  is  the  be 
lief  that  such  diseases  arise  from  the  combined  influence  of  those 
two  agencies.  In  most  of  the  instances  mentioned,  humidity,  when  it 
existed,  was  associated  witn  atmospheric  heat,  and  yet  the  combina 
tion  failed  to  prove  injurious.  Dr.  Drake  remarks,  in  corroboration, 
that  autumnal  fever  seldom  appears  on  board  of  vessels  which 
cruise  in  the  Gulf  of  Mexico,  although  the  air,  at  the  temperature 
of  80°,  is  nearly  saturated  with  vapour ;  that  the  inhabitants  of  Key 
West,  who  breathe  a  similar  atmosphere,  are  much  less  afflicted 
with  the  fever  than  those  on  the  Peninsula  of  Florida,  several 
degrees  farther  north  ;  that  the  pine  woods  around  the  Gulf  of 
Mexico,  at  the  distance  of  only  two  or  three  miles  from  the  estua 
ries  of  the  rivers,  are  places  of  retreat  from  fever,  although  there 
is  a  sea  and  land  breeze  which  tends  to  equalize  the  humid  atmo 
sphere  ;  that  the  inhabitants  of  the  Balize  suffer  less  from  the  fever 
than  those  along  the  rivers  of  the  interior  of  Louisiana,  two  or  three 
degrees  farther  north,  notwithstanding  they  are  immersed  in  an 
atmosphere  of  great  heat  and  vapour;  that,  at  our  different  salt 
works,  the  operatives  spend  their  lives  in  a  hot  atmosphere,  satu 
rated  with  vapour,  and  yet,  on  the  whole,  are  more  exempt  from 
fever  than  the  surrounding  population;  and,  lastly,  that  in  some  of 
our  manufacturing  establishments,  the  in -door  artisans  and  opera 
tives  labour  in  a  heated  atmosphere  supersaturated  with  vapour, 
but  remain  free  from  autumnal  fever.  To  this  it  may  be  added, 
that  in  the  plains  of  Meta,  situate  on  the  east  side  of  the  Cordilleras, 
fever  does  not  prevail  extensively,  while  in  the  valley  of  the  Mag- 
nalena,  on  the  west  of  those  mountains,  it  is  of  almost  constant 


AUTUMNAL   FEVEKS.  169 

occurrence ;  yet  the  state  of  the  barometer,  as  well  as  the  hygro- 
metrical  variations,  are  the  same  in  both  places.1 

These  various  facts,  showing  the  innocuousness  of  the  combination 
in  question,  lead  to  the  inference  that,  when  the  prevalence  of  fever 
happens  to  be  associated  with  the  existence  of  heat  and  moisture 
combined,  the  cause  of  the  disease  is  not  to  be  sought  in  the  latter, 
inasmuch,  particularly,  as  we  find  that  febrile  complaints  occur 
often,  and  spread  widely  and  fatally,  without  any  such  combination. 
Humidity,  therefore,  if  instrumental  in  producing  fever — and  no 
one  will  deny  the  fact — must,  as  already  stated,  act  in  a  secondary 
capacity ;  and,  instead  of  being  regarded  as  the  efficient  cause  when 
alone  or  combined  with  heat,  must  be  viewed  as  merely  aiding  in 
the  elimination  of  the  latter,  and  predisposing  the  system  to  its 
morbid  effects. 

Vicissitudes  of  temperature  icill  not  account  for  the  occurrence  of  periodic 
fever. — Neither  can  we  admit  the  propriety  of  referring  the  efficient 
cause  of  autumnal  and  kindred  fevers  to  the  difference  of  tempera 
ture  between  clay  and  night,  or  to  mere  atmospheric  vicissitudes — 
the  succession  of  cool  or  cold  nights  to  hot  days ;  nor  the  sudden 
exposure  of  the  body,  at  any  period  of  the  twenty-four  hours,  to  a 
low  degree  of  temperature  after  it  has  been  placed  for  a  greater  or 
less  extent  of  time  under  the  influence  of  a  high  degree.  The 
agency  of  such  vicissitudes  were  noticed  as  early  as  the  days  of 
Hippocrates.  Hoffman  sets  them  down  as  the  general  remote  cause 
of  epidemic  fevers,  and  after  him,  several  writers,  among  whom 
Broussais2  and  Dr.  Dundas3  figure  conspicuously,  have  laid  much 
stress  on  their  efficiency,  and  displayed  considerable  ingenuity,  in 
endeavouring  to  explain  the  manner  in  which  the  morbid  effects 
are  brought  about.  But  after  carefully  examining  what  the  advo 
cates  of  the  opinion  have  adduced  in  its  support,  it  appears  to  me 
that  were  atmospheric  vicissitudes  the  efficient  agent  in  the  pro 
duction  of  periodic  and  other  forms  of  malarial  fever,  we  might 
expect  to  find  these  diseases  prevailing  principally  in  seasons  in 
which  the  number  of  dew  or  cold  nights  following  on  hot  days  is 
greatest.  We  should  be  justified  also  in  expecting  malarial  fevers 

1  Boussingault,  An.  de  Chiraie,  Ivii.  153-4. 

2  Commentaires  des  Propositions,  No.  227,  pp.  672—3. 

3  Sketches  of   Brazil ;  including  New  Views  on  Tropical  and  European  Fevers. 
London,  1852,  205. 


170  PNEUMONIA    AND 

to  occur  not  once  or  occasionally,  but  frequently,  if  not  univers 
ally,  whenever  the  supposed  cause  manifests  itself;  or,  rather,  it 
ought  to  be  found  that  every  time  such  fevers  prevail — sporadic 
ally  or  epidemically — the  difference  of  temperature  between  day 
and  night  is  greater  than  in  healthy  seasons.  We  should  besides 
expect  to  find  them  appearing,  not  sporadically  only,  but  in  an  epi 
demic  form,  as  well  in  clean,  well-paved,  and  well-aired  cities,  where 
atmospherical  vicissitudes  are  as  apt  to  be  felt  as  elsewhere,  as  on 
the  borders  of  creeks,  rivers,  and  lakes,  and  in  meadow  lands,  in 
level  plains  or  marshy  localities ;  and  whenever  a  man  whose  body 
lias  been  overheated  is  suddenly  exposed  to  a  cold  atmosphere,  or 
plunged  into  a  cold  bath,  he  ought  to  be  regarded  as  no  less  liable 
to  suffer  from  an  intermittent,  a  remittent,  or  a  yellow  fever,  of  the 
most  legitimate  kind,  than  from  a  pleurisy,  a  catarrh,  or  any  other 
kindred  disease.  But  so  far  from  this  being  the  case,  experience 
shows  that  fevers  occur  and  prevail  extensively  in  situations  where, 
and  at  periods  when,  such  vicissitudes  are  not  felt  at  all,  or  are  so 
to  too  inconsiderable  an  extent  to  be  productive  of  the  baneful 
effects  ascribed  to  them ;  and,  on  the  other  hand,  that  those  diseases 
are  either  seldom  felt  or  completely  unknown  in  localities  where 
or  seasons  when,  sudden  changes  of  temperature,  or  the  contrast 
between  night  and  day,  are  as  common  and  noted  as,  if  not  more 
so  than,  in  places,  and  at  times  remarkable  for  insalubrity. 
Surely  a  morbid  agent  which,  if  it  really  exercises  any  influence  in 
the  production  of  autumnal  fevers,  does  so  only  in  localities  of  a 
special  kind,  where,  let  it  be  remembered,  those  fevers  often  appear 
and  even  abound  without  its  aid ;  an  agent  which  habitually  fails 
to  produce  those  same  fevers  in  localities  of  a  different  kind ;  which 
produces  the  effect  ascribed  to  it  only  in  a  certain  season  of  the 
year,  however  manifestly  it  may  show  itself  at  other  periods,  and 
whose  known  ordinary  products  everywhere  and  at  all  times,  are 
diseases  very  different  in  every  respect  from  those  in  question  ; 
such  an  agent,  I  say,  cannot  lay  a  just  claim  to  be  held  in  the  light 
of  the  efficient  or  necessary  cause  of  the  latter. 

The  climate  of  Newfoundland  is  marked  by  sudden  and  fre 
quent  vicissitudes  of  atmosphere  ;  notwithstanding  which,  however, 
fevers  are  scarcely  known  there,  even  among  those  most  exposed.1 
The  whole  coast  of  this  continent,  from  one  extremity  to  the 

J  Tullock,  Sickness,  &c.  of  British  Army  iu  British  America,  35. 


AUTUMNAL    FEVERS.  171 

other,  is  proverbial  for  the  frequency,  suddenness,  and  extent  of 
such  changes ;  and  yet,  while  some  localities  are  annually  the  seat 
of  the  pyrexial  complaints  under  consideration,  others,  equally  sub 
ject  to  the  former,  remain  untouched  by  the  disease.  Nay,  vicissi 
tudes,  if  really  the  efficient  cause  of  malarial  fevers,  appear  to  be 
whimsical  in  their  operations.  See,  for  example,  how  they  com 
port  themselves  in  Charleston.  The  autumnal  seasons  of  18-49  and 
1852  were  decidedly  malarial.  During  the  months  of  July,  August, 
and  September  of  the  first,  the  number  of  nights  of  dew,  with  high 
temperature  during  the  day,  amounted  to  51,  and  far  exceeded  that 
of  1845-8  and  1851,  and  by  8  that  of  1850,  in  neither  of  which 
years  did  the  yellow  fever  prevail.  So  far,  therefore,  there  seems 
to  be  some  connection  as  cause  and  effect  between  cold  nights  with, 
hot  days  and  fever.  But  when  we  come  to  inquire  into  the  results 
obtained  in  1852 — which  was  a  decidedly  malarial  year,  as  evi 
denced  by  the  occurrence  of  both  the  yellow  fever  and  dengue,  we 
find  that  the  number  of  dew-nights  amounted  only  to  39,  or  4  less 
than  in  1850,  when  there  was  no  malarial  developments,  and  the 
range  of  the  temperature  was  greater.  For  this  fact,  we  are  in 
debted  to  Dr.  Hume,1  already  referred  to.  The  range  in  1849,  dur 
ing  July,  August,  and  September,  amounted  to  1,524  degrees  (the 
minimum  or  night  temperature  being  63.92,  and  the  maximum  or 
dry  temperature  being  79.16),  and  exceeded  by  far  that  of  1845— 
6-7-8-50-51.  But  the  range  in  1852  was  only  1,284  (minimum 
66.25,  maximum  78.91),  being  only  26  degrees  higher  than  the 
range  of  1851,  and  less  by  .82  than  that  of  1850,  when  the  mini 
mum  was  68.00,  and  the  maximum  81.58.  In  a  word,  the  resem 
blance  of  1850  and  1851  with  1852,  is  too  striking  in  this  and 
other  respects,  to  make  us  attach  much  importance  to  this  point.2 

It  may  not  be  improper  to  remark,  1st,  that  persons  who  take 
the  fever  are  seldom  sensible  of  having  felt  the  effects  of  atmo 
spheric  vicissitudes,  and  often  have  been  placed,  purposely  or  acci 
dentally,  beyond  the  possibility  of  experiencing  these — supposing 
them  to  occur.  2d.  That  the  cold,  incident  to  such  vicissitudes,  acts 
on  organs  different  from  those  concerned  in  the  development  of  pe 
riodic  or  malarial  fevers.  Producing  its  first  impress  on  the  skin, 
it  affects  most  frequently  those  parts  which  act  as  supplements  to 
that  eliminating  tissue — the  lungs,  and  the  urinary  passages.  Other 

1  Charleston  Journal,  viii,  67,  2  Hume,  op.  cit.  58. 


172  PNEUMONIA    AND 

parts,  of  course — even  the  abdominal  viscera — are  sometimes  impli 
cated,  but  the  symptoms  which  then  occur  bear  no  resemblance  to 
those  of  autumnal  fevers,  unless  other  causes  have  co-operated. 
That  the  cold  felt  under  the  circumstances  is  instrumental  in  ex 
citing  or  multiplying  attacks  of  malarial  fevers,  is  no  doubt  true ; 
but  it  does  in  regard  to  these  diseases  what  it  effects  in  regard  to 
many  other  complaints;  and  it  would  be  wrong,  from  its  agency  in 
those  cases,  to  argue  that  it  is  the  efficient  cause  of  the  disease ;  for, 
alone,  it  cannot  give  rise  to  anything  of  the  kind.  More  rational  is 
it  to  view  it  as  having  simply  aroused  from  its  slumbers  a  morbific 
influence  floating  in  and  impressing  the  system  in  a  slow  and  invisi 
ble  manner,  and  requiring,  for  its  outward  manifestatioD,  the  dis 
turbing  influence  of  some  other  agency.  The  same  result  attends 
the  action  of  atmospheric  vicissitudes  in  regard  to  diseases  of  a 
specific  nature,  and  which  no  one  would  have  the  hardihood  to 
ascribe  solely  to  such  a  cause.  What  the  latter  does  as  respects 
malarial  fevers,  it  does,  for  example,  in  regard  to  mercurial  ptya- 
lism  in  persons  whose  systems  have  been  impregnated  with  mer 
cury;  but  in  whom  the  affection  of  the  mouth  has  not  yet  been 
developed.  In  such  instances,  exposure  to  atmospheric  vicissi 
tudes — to  cold,  however  applied,  especially  when  the  system  has 
been  previously  heated — will  hasten  and  increase  the  elimination 
of  the  poison,  and  salivation  will  be  established.  The  same  remarks 
apply  equally  well  to  hydrophobia,  which  has  not  unfrequently 
been  developed  through  the  agency  of  the  cause  in  question. 
Nothing  is  more  dangerous  than  the  action  of  atmospheric  vicissi 
tudes,  or  cold,  011  individuals  bitten  by  the  lanceolated  trigono- 
cephalus  of  the  Antilles.  The  same  injurious  effect  is  said  to  be 
experienced  by  individuals  who  have  been  exposed  to  the  action 
of  the  mancinella  and  the  Rhus  toxicodendron.1 

In  all  these  instances  of  change  from  heat  to  cold,  the  latter  has 
acted  simply  as  an  exciting  cause,  and  must  be  ranked  with,  for  it 
acts  much  in  the  same  way  as,  several  other  agencies — intemperance 
in  eating  or  drinking,  venereal  excesses,  exciting  and  depressing 
passions  of  the  mind,  &c. — which  no  one  in  his  senses  can  feel  dis 
posed  to  regard  as  capable  of  producing  periodic  or  malarial  fevers, 
any  more  than  of  producing  ptyalism  or  hydrophobia. 

1  Bouclin,  Gcog.  Mod.  07. 


AUTUMNAL    FEVERS.  173 

The  attack  is  sometimes  too  sudden,  and  follows  on  too  transient  an  ex 
posure  to  infected  regions,  without  appreciable  atmospheric  vicissitudes, 
to  be  the  effect  of  these  or  any  oilier  kindred  cause. — It  is  not  less 
true  that  the  attack  comes  on  often  too  suddenly,  is  too  palpably 
connected  with  a  transient  exposure  to  an  unhealthy  spot ;   and 
appears  under  circumstances  which  too  evidently  shut  out  the  idea 
that  atmospheric  vicissitudes  have  had  an  agency  in  its  production, 
to  justify  us  in  viewing  these  in  the  light  of  the  efficient  cause  of 
the  disease.     Who  has  not  seen  or  read  of  persons  being  seized 
with  intermittent,  remittent,  or  yellow  fever,  after  a  single  and  mo 
mentary  exposure,  not  at  night  only,  but  sometimes  during  the  day, 
to  the  atmosphere  of  infected  localities,  who,  before  such  exposure, 
had  borne,  with  perfect  impunity,   as  thousands  of  other  indivi 
duals  were  continuing  to   do,  the  thermometriqfil  vicissitudes  of 
neighbouring  localities.      The  facts  on  the  subject  mentioned  by 
Humboldt,  respecting  persons  taking  the  yellow  fever  in  conse 
quence  of  passing  through  Yera  Cruz  in  a  litter,  with  a  view  to 
embark,  are  familiar  to  most  readers,1  and  others  of  similar  im 
port  may  be  easily  gathered  from  the  annals  of  periodic  fevers. 
I  could,  if  necessary,  relate  several  instances  of  individuals  who 
have  been  seized  with  yellow  fever  after  remaining  but  an  hour  or 
two  in  the  city  of  Havana.     The  history  of  all  our  epidemics  fur 
nish  us  with  examples  of  the  sort.     In  1798,  Dr.  Cooper,  who  was 
residing  at  Bush  Hill,  imprudently  visited  the  infected  district,  and 
was  a  short  time  after  attacked.     During  the  fever  of  1820,  in  this 
city,  a  young  man,  residing  in  a  healthy  district,  jumped  over  the  bar 
ricades,  walked  through  the  deserted  streets  for  a  few  moments,  and 
paid  the  penalty  of  his  imprudence.     "  If  my  own  frequent  observa 
tions,"  says  Macculloch,  "  show  that  fever  may  be  induced  within 
half  an  hour  after  exposure  to  malaria,  and  that  a  single  inspira 
tion,  in  the  space  of  a  very  few  seconds,  is  amply  sufficient  for  the 
purpose,  this  is  also  an  opinion  most  decidedly  stated  by  many 
French  and  Italian  physicians,  whose  experience  and  acuteness  will 
not  be  questioned.     It  is  equally  the  opinion  of  others  elsewhere, 
not  physicians,  and   therefore  without   the  bias  which  might  be 
suspected  in   such  cases;  of  military,   and  chiefly  of  naval  men, 
whose  observations  have  been  founded   on  the   momentary   and 
transitory  effects  of  a  breeze  of  wind,  and  especially  of  a  land-wind 

1  Nouvelle  Espagne,  4to.  ed.  778-4. 


174:  PNEUMONIA    AND 

blowing  off  to  sea.  In  France  and  Italy,  to  confirm  this,  instances 
are  known  and  recorded,  of  labourers  dying  instantaneously  from 
merely  sitting  or  lying  clown  on  the  ground,  and  of  others  who, 
from  looking  into  a  ditch  or  drain,  have  been  struck  dead  by  that 
poison,  which,  of  course  in  a  minor  degree,  has  merely  produced  a 
fever."1  But  as  these  statements  may  be  objected  to  on  the  score  of 
the  tendency  to  exaggeration  with  which  Macculloch  has,  perhaps 
not  unjustly,  so  often  been  charged,  it  may  not  be  improper  to  re 
mark  that  the  fact  of  infection  after  transient  exposure,  derives 
ample  support  from  the  asseverations  of  other  writers  whose  testi 
mony  cannot  be  impugned.  Lancisi  relates  that  of  a  party  of 
thirty  gentlemen  and  ladies  of  rank  in  Rome,  who  made  an  excur 
sion  towards  the  mouth  of  the  Tiber,  the  wind  suddenly  shifted, 
and  blew  from  the  south  over  the  marshes,  when  twenty-nine  were 
soon  seized  with  a  tertian  fever.2  "  The  marines,"  says  Lind,  "  who 
were  three  times  a  week  exercised  early  in  the  morning  on  South 
Sea  Beach  (in  1765),  from  the  effect  of  the  stagnant  water  of  an 
adjoining  morass,  suffered  much.  Half  a  dozen  of  them  at  a  time 
were  frequently  taken  ill  in  their  ranks,  when  under  arms;  some 
were  seized  with  such  a  giddiness  in  the  head  that  they  could 
scarcely  stand;  others  fell  down  speechless,  and,  upon  recovering 
their  senses,  complained  of  a  violent  headache.  "When  such  pa 
tients  were  received  into  the  hospital,  some  few  had  a  regular  ague, 
but  far  the  greater  number  laboured  under  a  remitting  fever,  in 
which  sometimes,  indeed,  there  was  no  perceptible  remission  for 
several  days."3  Ferguson  says,  of  Monk's  Hill :  "  It  was  the 
duty  of  the  white  troops,  in  both  these  forts,  to  take  the  guard  and 
duties  of  the  dock-yard  amongst  the  marshes  below,  and  so  pestife 
rous  was  their  atmosphere  that  it  often  occurred  to  a  well-seasoned 
soldier,  mounting  the  night-guard  in  perfect  health,  to  be  seized 
with  furious  delirium  while  standing  sentry,  and,  when  carried  back 
to  his  barracks  on  Monk  Hill,  to  expire  in  all  the  horrors  of  the 
black  vomit,  within  less  than  thirty  hours  of  the  first  attack."4 
The  same  writer  states  that,  during  the  advance  of  the  British  army 
from  Oporto  in  1809,  the  troops  took  up  their  bivouac  in  the  dried- 

1  Essay  on  Remittent  Fever,  &c.  i.  16. 

2  De  Nox.  Palud.  Effl.  lib.  ii.  cap.  3. 

3  Dis.  of  Hot.  dim.  24,  5.      See,  also,  32,  89;   159-100;   240-242.      Ib.  on  Sea 
men,  81. 

4  Marsh  Poison,  in  vol.  of  Recollections,  194—5. 


AUTUMNAL    FEVEES.  175 

up  beds  of  the  mountain  streams.  These  localities  proved  highly 
unhealthy,  and  several  of  the  men  were  seized  with  violent  remittent 
fever  before  they  could  move  from  the  bivouac  the  following  morn 
ing.1  Dr.  Celle,  in  his  Hygiene  des  Pays  Ghauds  (79),  relates  the  fol 
lowing  instance  of  the  sudden  influence  of  miasma:  "  In  1844,  eight 
soldiers,  an  officer,  and  a  custom-house  agent,  were  sent  from  San 
Bias  to  the  environs  to  surprise  a  convoy  of  silver  which  had  been 
reported  as  about  being  embarked  by  contraband.  They  con 
cealed  themselves  in  a  thicket,  close  to  a  marsh.  An  hour  after, 
they  were  all  seized  with  vertigo,  nausea,  vomiting,  and  an  exces 
sively  violent  chill ;  in  such  a  way,  indeed,  that  the  convoy  passed 
without  one  of  the  men  being  able  to  rise  from  the  ground  to  seize 
it."  The  same  writer  states  that  similar  occurrences  are  noticed 
among  the  soldiers  and  custom-house  officers  stationed  at  the  en 
trance  of  the  port  of  Mazatlan.  The  station  is  situate  between  the 
sea  and  a  marsh.  The  men  are  on  duty  during  twenty-four  hours 
only,  yet,  at  the  end  of  this  short  time,  it  generally  happens  in  the 
rainy  season  that  they  all  return  with  fever  or  dysentery  (80).  "  It 
is  a  curious  thing,"  says  an  official  document,  "  to  see  six  men  sent 
ashore  in  perfect  health,  return  on  board  ten  minutes  after,  all  six 
labouring  under  fever."2  Nepple  relates  the  history  of  eight  men 
who,  during  the  hot  weather  of  August,  1825,  were  employed  in 
thrashing  in  a  barn  situate  in  the  immediate  vicinity  of  a  source  of 
infection  near  the  town  of  Montluel.  They  were  all  seized  the  same 
day  with  intermittent  fever  of  greater  or  less  violence.3 

Before  the  English  raised  the  blockade  (of  Batavia)  parties  of 
men  and  officers  were  sent  on  shore  at  Edam,  to  blow  up  and  de 
stroy  the  works  and  buildings  on  the  island,  which  operations  de 
tained  them  about  half  the  night  there.  Most  of  them  were  shortly 
afterwards  attacked  with  the  fever.4  Mr.  Lander,  surgeon  to  Lord 
Eothe's  regiment  of  horse,  communicated  the  following  informa 
tion  to  Sir  John  Pringle :  Most  of  the  men  were  first  taken  ill 
upon  their  return  from  forage ;  for,  the  regiment  being  cantoned 
upon  the  right  and  left  of  St.  Michael's  Gestel  (their  principal 
quarters),  close  upon  the  inundations,  and  many  of  the  quarters 
being  above  two  leagues  from  Bois-le-duc,  where  the  magazines 

1  Ibid.  2  Admiralty  Reports. 

3  Fievres  Intermittentes,  142.     See,  for  other  cases  of  similar  kind,  Second  Rep.  of 
Lond.  Commiss.  for  1848,  96;   Bryson,  205;  Johnson  on  Trop.  Climates,  127. 

4  Johnson  on  Tropical  Climates,  134. 


176  PNEUMONIA    AND 

were  kept,  the  men  were  obliged  to  set  out  about  four  in  the 
morning,  in  order  to  get  back  before  the  greatest  heat  of  the  day. 
At  this  early  hour,  the  meadows  and  marshes  on  each  side  of  the 
road  were  covered  with  a  thick  fog  of  an  offensive  smell,  which 
Mr.  L.  considered  as  the  chief  cause  of  the  sickness.  For,  although 
the  party  generally  returned  before  noon,  several  among  them  were 
already  in  a  fever,  and  some  actually  delirious ;  nay,  a  few  on  their 
way  home  were  so  suddenly  taken  with  a  frenzy,  as  to  throw 
themselves  from  their  trusses  into  the  water,  imagining  that  they 
were  to  swim  to  their  quarters.1 

Mr.  Grainger,  in  his  testimony  before  "the  London  Commis 
sioners,"  quotes  a  letter  from  a  medical  practitioner:  "I  was  passing 
the  drain-grating  at  the  corner  of  Union  and  Bond  Street,  when  I 
perceived  a  most  faint  and  disagreeable  smell  arising  from  it.  Being 
immediately  attacked  with  nausea  and  an  indescribable  sensation  of 
illness,  I  at  once  returned  home,  and  drank  half  a  wineglassful  of 
brandy.  After  a  short  time  the  indisposition  appeared  to  pass  away, 
but  the  peculiar  smell  of  the  drain  still  remained  in  iny  nostrils.  I 
had  to  visit  a  patient  near  Manchester  Square,  that  evening,  and 
whilst  in  the  house,  I  felt  so  ill  that  I  immediately  returned  home 
and  went  to  bed.  At  that  time  my  head  ached  violently.  I  had 
nausea,  pain  in  my  back,  and  an  unpleasant  taste  in  my  mouth.2" 

All  these  cases,  and  others  equally  striking,  which  it  would  be 
easy  to  adduce,  show,  beyond  the  possibility  of  denial,  that  periodic 
or  autumnal  fevers,  of  all  grades  and  forms — from  the  most  trifling 
to  the  most  malignant — are  often  produced  almost  suddenly  by  the 
shortest  possible  exposure  to  sickly  localities ;  and  it  is  certainly 
difficult  to  understand  how  atmospheric  vicissitudes  can  alone  be 
looked  upon  as  the  chief  agent  in  the  production  of  such  diversified 
effects ;  seeing  especially  that  the  morbid  changes  to  which  they 
usually  give  rise  differ  materially  from  those  under  present  con 
sideration.  Add  to  this,  that  atmospheric  vicissitudes  are  not 
greater,  and  cannot  be  more  deleterious  near  to,  or  to  the  wind 
ward  of  a  morass,  than  at  a  short  distance  from,  or  to  the  leeward 
of  it;  along  the  margin  of  a  lake  or  river,  than  on  its  surface  a  few 
hundred  rods  off;  in  a  sickly  port  than  at  a  short  distance  outside ; 
and  that,  if  they  produce  the  fever  in  the  former,  there  is  no  reason 
why  they  should  not  do  so  equally  well  in  the  latter. 

1  Tringle,  177-8.  2  Kept,  1848,  96. 


AUTUMNAL    FEVERS.  177 

Fever  not  the  effect  of  a  particular  electrical  state  of  atmosphere. — 
Not  more  satisfactory  is  the  hypothesis  that  the  efficient  and  neces 
sary  cause  of  autumnal  fever  must  be  sought  in  some  particular  elec 
trical  or  magnetic  state  of  the  atmosphere.  On  this  subject  we 
know  too  little  to  form  even  a  plausible  conjecture ;  and  I  hazard 
nothing  in  affirming  that  the  various  theories  of  Giannini,  Mur 
ray,  Craig,  Shecut,  Eumph,  Pallas,  and  others,  have  failed  to 
satisfy  medical  inquirers  of  sound  judgment.  The  sphere  of  pre 
valence  of  the  disease  is  often  circumscribed  within  such  narrow 
and  well-defined  boundaries,  that  it  is  difficult  to  perceive  the  pro 
priety  of  regarding  it  as  due  to  any  modification  in  an  agent  of  the 
general  and  wide-spread  character,  necessarily  possessed  by  the 
one  under  consideration.  This  modification,  whatever  it  may  be, 
whether  it  consist  in  an  excess  or  deficiency  of  the  fluid,  extends 
far  and  wide,  and  cannot  fail  to  exercise  its  influence,  as  well  at  a 
distance  from,  as  within  the  precincts  of,  the  sickly  district;  and 
were  the  theory  correct,  we  should  not  hear  of,  and  every  day  see, 
instances  of  fever  being  arrested  by  a  street,  a  wall,  or  the  like ;  or 
extending  its  ravages  over  a  very  limited  surface  of  ground,  in  a 
single  ship,  or  side  of  a  ship,  on  one  side  of  a  street,  &c.  The  same 
modification  in  the  electricity  of  the  atmosphere  must  have  existed 
beyond  those  narrow  limits;  and  if  it  were  the  sole  cause  of  the  fever 
on  one  side  of  the  barrier,  it  would  in  all  probability  have  produced 
a  similar  effect  on  the  other.  Some  other  agent,  then,  must  have 
been  at  work  in  the  former,  which  did  not  exist  in  the  latter.  It 
matters  not  whether  the  sickly  locality  covers  a  small  area  of 
ground,  or  extends  over  a  wide  surface,  the  necessity  of  that  pecu 
liar  agent  must  be  admitted ;  and  while  it  would  be  improper  to 
deny  that  a  modified  state  of  atmospheric  or  terrestrial  electricity 
exercises  an  influence  in  the  formation  of  the  supposed  agent,  and, 
in  addition,  predisposes  the  system  to  be  morbidly  affected  by  it, 
we  must  necessarily  absolve  it  from  the  charge  of  acting  as  the  sole 
efficient  cause  of  the  disease. 

The  preceding  facts  lead  to  the  lelief  in  a  poisonous  agent  floating 
in  the  atmosphere. — All  the  above  hypotheses  failing  to  account  for 
the  effects  in  question,  we  are  naturally  led  to  the  admission  that  they 
are  produced  by  the  morbific  influence  of  some  special  agent ;  and 
when  we  take  into  consideration  all  the  circumstances  attending  the 
appearance  of  febrile  diseases,  the  circumscribed  sphere  of  their 
12 


178  PNEUMONIA    AND 

prevalence,  the  suddenness  of  their  attack,  the  character  of  their 
phenomena,  &c.,  we  may  safely  say  that  there  is  nothing  left  but  to 
attribute  them  to  the  action  of  some  poison  dissolved  or  suspended 
in,  and  contaminating  the  air  of  the  infected  locality;  which  poison, 
while  doubtless  requiring  for  its  development  and  dissemination  a 
certain  degree  of  heat  and  terrestrial  and  atmospheric  moisture,  a 
certain  amount  of  nightly  condensation  after  evaporation,  and  the 
presence  of  fermenting  or  decomposing  materials,  cannot  be  pro 
duced  by  either  of  these  agencies  alone ;  and,  though  undetected  by 
the  chemist,  betrays  its  presence  by  producing  on  those  exposed  to 
its  influence  the  peculiar  morbid  changes  characterizing  fever. 

The  innociwusness  of  some  marshes,  and  of  localities  similar  to  those 
that  are  sickly,  no  proof  of  the  non-existence  or  non-agency  of  malaria. — 
That  marshes  and  swampy  surfaces — using  these  terms  in  their  more 
enlarged  sense — collections  of  organic  substances  in  a  state  of  de 
composition,  &c.,  do  not  occasion  the  effect  in  question  always  and 
everyiuhere;  that  ships  at  sea  and  in  port,  though  often  superabund 
antly  filled  with  such  materials  of  decomposition,  are  not  invariably 
the  seat  of  febrile  developments  in  a  sporadic,  and  especially  in  an 
epidemic  form,  all  must  know  who  have  paid  attention  to  the  sub 
ject.  During  particular  seasons,  in  places  presenting  some  of  the 
peculiar  characteristics  specified,  cases  of  fever  abound.  During 
others,  and  sometimes  during  a  succession  of  seasons,  the  disease 
is  scarcely,  if  at  all  seen.  In  the  quebradas  of  Peru,  fevers  are 
often  general,  and  assume  the  garb  of  wide-spreading  and  malignant 
epidemics.  This  continues  a  year  or  two,  during  which  the  mortal 
ity  becomes  very  considerable.  At  the  end  of  that  time  a  favoura 
ble  change  takes  place,  and  the  country  once  more  becomes  healthy.1 

In  a  medical  report  of  the  House  of  Kecovery  of  Dublin  for 
1829,  Dr.  O'Brien  says :  "Intermittent  fever  has  been  a  rare  disease 
in  Dublin,  and,  we  may  add,  in  Ireland.  During  a  period  of  twenty 
years,  through  which  the  author's  experience  extends,  a  few  inci 
dental  cases  only  of  the  disease  occurred,  from  time  to  time,  in  his 
hospital  and  dispensary  practice,  and  those  few  were  persons  who 
brought  the  disease  from  England.  A  singular  revolution  has 
taken  place  in  Dublin  for  the  last  two  years  with  respect  to  inter 
mittent  and  continued  fevers ;  the  latter  disease,  which,  for  a  cen- 

1  Ulloa,  Mem.  Fhilos.  i.  245. 


AUTUMNAL    FEVERS.  179 

tury,  had  been  the  constant  scourge  of  this  city,  has  considerably 
declined,  and  intermittent  fever  has  sprung  up,  and  occupied  its 
place.  For  the  last  four  months,  however,  up  to  February,  1830, 
intermittent  fever  has  again  disappeared,  and  I  am  happy  to  say, 
without  a  corresponding  increase  of  continued  fever."1 

I  shall  not  stop  to  show  that  the  same  alternation  of  healthy  and 
sickly  periods  in  localities  where,  from  the  nature  of  the  soil,  and 
some  of  their  external  conditions,  fever  might  at  first  sight  be  ex 
pected  to  arise  annually,  has  been  noticed  in  this  country  and  else 
where.  The  task  would  offer  no  difficulty,  for  facts  to  the  point 
could  be  abundantly  supplied  by  the  Transactions  of  our  State 
Medical  Society,2  and  a  variety  of  works  of  easy  access.  But  the 
subject  has  already  been  alluded  to,  and  may  be  reverted  to  again 
under  a  different  head,  and  must,  besides,  be  familiar  to  all  well- 
informed  and  observant  physicians. 

It  not  unfrequently  happens  that  in  localities  where,  from  the 
character  of  the  soil,  or  the  nature  and  condition  of  the  substance 
by  which  the  surface  is  covered,  as  well  as  from  the  heat  and  moist 
ure  of  the  climate,  febrile  complaints  might  be  expected  to  occur, 
they  are,  nevertheless,  seldom  or  never  encountered.  We  have 
already  seen  that  many  parts  of  Scotland  and  Ireland  that  are 
occupied  by  large  tracts  of  peat  moss  are  completely  free  from 
these  fevers,  and  that  the  disease  is  never  seen  among  the  inhabi 
tants  of  the  country  bordering  on  the  Dismal  Swamp  between  Vir 
ginia  and  North  Carolina.  The  numerous  and  extensive  marshes 
of  Sweden,  somewhat  beyond  the  sixtieth  degree  of  latitude,  of 
Norway,  of  Eussia — near  St.  Petersburg,  for  example — of  Laponia, 
&c.,  have,  it  is  said,  little  influence  on  the  mortality  or  salubrity  of 
those  regions ;  intermittents  and  remittents  not  being  endemic  there;3 
and  every  one  knows  that,  whatever  be  the  condition  of  the  towns 
and  cities  of  these  regions,  or  of  Northern  Europe  generally,  yellow 
fever,  properly  so  called,  has  never,  except  perhaps  at  Copenhagen 
— and  even  this  is  open  to  doubt — made  its  appearance  there. 

Intermittents  are  almost  unknown  on  the  banks  of  the  Khine  from 
its  source  to  Chur.  Making  their  appearance  near  this  place,  they 

1  Dublin  Med.  Trans.  N.  S.  i.  330-1. 

2  See  Trans,  of  Med.  Soc.  of  the  State  of  Pennsylvania,  ii.  51,  93. 

3  Monfalcon,  2G  ;  Acerbi  Viaggio  al  Capo  Norte ;  Brocchi,  op.  cit.  277 ;  Brit,  and 
For.    Med.-Chir.   Rev.   x.   367;    Bovidin,  An.   d' Hygiene,   xxxiii.    116;   Bang.   Prax. 

Med.  36. 


180  PNEUMONIA    AND 

continue  to  show  themselves  as  far  as  Maienfeld,  where  they  again 
disappear,  to  break  out  anew,  and  prevail  from  Strasburg  to  Bingen. 
A.t  this  spot  they  once  more  are  lost  sight  of,  and  are  not  seen 
before  reaching  Cologne,  and  especially  the  delta  of  the  above-men 
tioned  river.1 

On  the  summit  of  the  group  of  Calabrian  mountains,  denominated 
La  Sila,  the  larger  portion  of  which,  formerly  covered  with  forests, 
is  at  present  under  culture,  are  to  be  found  extensive  marshy 
localities.  One  of  these,  situate  in  the  valley  of  the  Crocifisso, 
between  Cecio  and  Camiliati,  is  very  large.  From  these  marshes 
arise  thick  fogs,  which  float  on  the  surface  to  the  height  of  many 
feet,  and  continue  to  do  so  till  dissipated  by  the  action  of  the  sun ; 
yet  the  peasants  sleep  with  perfect  impunity  along  the  margin  of 
these  marshes  during  summer  and  autumn,  and  the  proprietors  re 
side  there  the  whole  of  that  time  in  the  Hotel  or  Casino  of  Cecio.2 

It  will  be  found  that,"fn  cold  climates,  periodic  or  malarial  fevers, 
generally  considered,  diminish  in  frequency  in  proportion  to  the 
elevation  of  the  latitude,  but  that  in  so  doing  they  conform  less  to 
the  direction  of  the  parallels  than  to  that  of  the  isothermal  lines.  M. 
Boudin,3  who  has  called  attention  particularly  to  this  circumstance, 
remarks  that,  though  but  little  prevalent  at  St.  Petersburg,  which, 
nevertheless,  is  surrounded  with  marshes  and  situate  under  the 
59°  of  north  latitude,  they  cease  to  exist  in  Asia  towards  the  57°, 
whilst  in  Sweden,  they  show  themselves  as  far  as  the  63°  of  the 
same  latitude,  and  even  reach,  somewhat  farther  in  a  westerly 
direction,  the  Shetland  Islands,  and  even  Iceland.  From  this,  it 
results  that  the  northern  limit  of  intermittent  fever  is  in  some 
measure  represented  by  the  isothermal  line  determined  by  an 
annual  temperature  of  5°  centigrade,  with  a  mean  of  0  in  winter, 
and  10°  in  summer ;  and  that  this  line  lowers  in  Central  Asia  and 
in  North  America  below  the  50°  of  north  latitude;  whilst  between 
those  two  continents  and  on  the  Atlantic  Ocean  it  rises  as  high 
as  the  67°  of  the  same  latitude. 

The  marshy  grounds  on  the  south-west  coast  of  Ceylon,  between 
Negombo  and  Galle,  do  not  seem  to  exercise  much  influence  in  the 
production  of  fever.  Again,  the  island  of  Mauritius,  in  the  Eastern 
hemisphere,  resembles  Jamaica  in  its  physical  characters.  The 

1  Boudin,  Fiovrcs  Intcrmittentes,  58. 

2  Brocchi  Stratto  Fiscio  del  Suollo  di  Romn,  &c.  278. 

3  Geographic  Medicalc,  10. 


AUTUMNAL    FEVERS.  181 

temperature  is  the  same ;  it  lies  nearly  in  the  same  latitude,  but  to 
the  south  of  the  line ;  morasses  and  marshy  land  occur  as  frequently 
in  the  one  as  in  the  other,  and  yet  periodic  fevers  are  rare  in  the 
Mauritius,  and  the  mortality  small  from  this  cause ;  while,  in 
Jamaica,  the  reverse  is  the  case,  remittent  fever  being  a  common 
and  fatal  disease.1 

In  many  parts  of  New  England,  as  far  as  the  St.  Lawrence,  New 
Brunswick,  Nova  Scotia,  and  Lower  Canada,  Forts  Moultrie,  and 
Munroe,  Hancock  Barracks,  West  Point,  etc.,  fever  is  seldom,  if 
ever  noticed,  though,  judging  from  the  external  appearances  and 
position  of  those  localities,  some  of  which  are  at  the  outlet  of  rivers, 
and  exposed  to  that  combination  of  mud  and  marsh,  regarded  as 
its  prolific  source  in  other  parts,  there  is  nothing  by  which  we  can 
account  for  the  exemption.2  Dr.  Drake,  who  has  paid  considerable 
attention  to  this  subject,  remarks  that  the  geographical  limits  of 
fevers  in  this  country  are  east  of  the  Appalachian  Mountains  below 
the  83°  of  latitude,  beyond  which  those  mountains  do  not  extend. 
Below  that  parallel,  it  has  no  eastern  limit  but  the  Atlantic  Ocean. 
South-west,  the  Cordilleras  of  Mexico  and  the  Southern  Eocky 
Mountains,  constitute  its  boundaries.  In  higher  latitudes,  it  ceases 
in  the  great  plains  of  our  western  desert,  long  before  we  reach 
those  mountains.  It  is  almost  unknown  at  the  distance  of  three 
hundred  miles  from  the  western  boundary  of  the  States  of  Missouri 
and  Iowa,  above  the  latitude  of  37°  N.  To  the  north,  it  does  not 
prevail  as  an  epidemic  beyond  the  44°  parallel,  and  ceases  to  occur 
even  sporadically  about  the  47°.3 

Dr.  Carpenter  states  that  on  the  bayous  of  the  Louisiana  delta, 
Lafourche  and  Terrebonne,  for  example,  the  habitable  land  is  limited 
to  narrow  strips,  of  from  a  few  hundred  feet  to  a  mile  in  width, 
which  form  the  banks  of  the  streams,  and  follow  their  windings, 
and  which  are  surrounded  on  all  sides  by  swamps  and  marshes,  in 
some  places,  and  in  others,  open  and  exposed ;  yet,  notwithstanding, 
these  regions  are  more  exempt  from  fevers  than  almost  any  other 
portion  of  the  State.4  Diseases  arising  from  malaria  might  be 
expected  to  be  very  prevalent  in  the  valley  of  the  Sacramento, 
containing,  as  it  does,  thousands  of  acres  of  land  subject  to  annual 
overflow,  and  from  which  there  is  no  escape  for  the  water,  except 

1  Tullock,  Sickness  and  Mortality  of  British  Army,  1G,  45.  B. 

2  Forry,  op.  cit.  278-0.  3  Op.  tit.  704. 
4  Carpenter  011  Periodicity,  N.  0.  J.  iii.  429. 


182  PNEUMONIA    AND 

by  the  slow  process  of  evaporation,  under  the  rays  of  an  intensely 
hot  sun ;  yet,  notwithstanding  this,  cases  of  intermittent  fever  are 
comparatively  rare  in  this  part  of  the  valley.  A  few  mild  cases  of 
intermittent  fever  occurred  in  the  neighbourhood  of  the  city  last 
spring ;  but  they  appeared  to  be  confined  to  low  localities  which 
are  situate  in  the  immediate  vicinity  of  stagnant  water.1 

Dr.  Tilton,  in  a  communication  to  Dr.  Currie,  states  that  the 
town  of  Lewes,  on  Cape  Henlopen,  in  the  State  of  Delaware,  is  so 
salubrious,  that  the  inhabitants  are  the  longest-lived  in  the  State, 
and  persons  affected  with  enlarged  spleen,  and  obstructed  viscera, 
from  repeated  atjacks  of  fevers,  are  speedily  restored  to  health  by  a 
residence  there.  Yet,  the  Cape  is  perfectly  surrounded  with  marshes. 
The  same  thing  is  observed  at  Bombay  Hook,  another  town  of  the 
same  State.2 

But  such  facts,  and  numerous  instances  of  vessels,  which,  though 
filthy  in  the  extreme,  remain  free  from  fever,  upon  which  Dr.  Dun- 
das  and  other  opponents  of  the  doctrine  of  malaria  seem  to  attach 
so  much  importance,  do  not,  true  as  many  of  them  doubtless  are, 
militate  against  the  views  here  advocated.  Neither  can  much  be 
made  out  of  the  fact,  often,  adduced,  that  the  true  yellow  fever  has  sel 
dom  prevailed  farther  south  than  the  Amazon  Kiver,  which  divides 
Brazil  from  Guiana,  though  materials  for  decomposition,  terrestrial 
and  atmospheric  humidity,  and  high  temperature,  exist  to  as  great 
an  extent  south  as  north  of  that  point ;  that  its  proper  soil  is  to  be 
found  in  the  West  Indies,  on  a  small  portion  of  the  coast  of  South, 
and  a  larger  one  of  North  America,  and  of  "Western  and  Eastern 
Africa,  embracing  an  area  which  extends  from  the  aforesaid  river  to 
Charleston  in  one  direction,  and  from  Barbadoes  to  Tampico  in 
another — to  say  nothing  of  its  appearing  occasionally  as  low  as  New 
York,  or  even  Boston,  as  well  as  in  some  parts  of  southern  Eu 
rope;  that  the  disease,  indeed,  can  scarcely  be  said  to  appear  south 
of  the  equatorial  line,  sparing  the  Atlantic  and  Pacific  coasts  of 
America,  south  of  the  Amazon ;  and  that  it  seldom  or  never  ap 
pears  in  the  East  Indies,  where,  notwithstanding  all  that  Valentin, 
Efirth,  Pugnet,  Lind,  Bancroft,  Chervin,  and  many  others  may  have 
said  to  the  contrary,  autumnal  fever  assumes  the  character  of  the 
bilious  remittent,  and  not  of  the  true  typhus  icterodes. 

1  Blalce,  On  the  Climate  and  Diseases  of  California,  N.  0.  J.  ix.  510. 

2  Currie  ;   Hist.  Account  of  the  Climate  and  Diseases  of  the  United  States,  211,  218. 


AUTUMNAL   FEVERS.  183 

In  reference  to  the  argument  against  the  malarial  origin  of  fever 
derived  from  the  exemption  from  the  disease  in  question  beyond 
the  limits  thus  assigned  to  it,  it  may  be  remarked  that,  admitting 
the  statements  on  which  it  is  predicated  to  be  correct,  the  exemp 
tion  in  question  could  not  be  used  successfully  to  disprove  the 
necessity  of  morbid  exhalations  in  the  production  of  the  fever ;  for, 
if  it  be  true  that  such  exhalations — which  must  exist  south  as  they 
do  at  the  equator  and  north  of  it — do  not  give  rise  to  the  disease 
beyond  the  limits  mentioned,  the  opponents  of  malaria  will  have  to 
explain  how  it  happens  that  the  causes  to  which  they  assign  it,  and 
which  they  must  allow  exist  in  as  full  force  on  one  side  as  on  the 
other  of  the  line,  do  not  occasion  the  effect.  If  such  causes  are,  from 
some  unexplainable  influence,  incapable  of  producing  that  form  of 
fever  south  of  that  line,  while  they  occasion  it  in  the  other  direc 
tion,  there  is  no  reason  why  the  same  may  not  be  the  case  with 
respect  to  exhalations.  But  we  may  go  farther,  and  deny  the  state 
ments  respecting  the  absence  of  yellow  fever  south  of  the  equator ; 
for,  though  it  be  true  that  in  South  America  the  disease  is  not  of 
such  frequent  occurrence  as  in  the  West  Indies,  and  on  the  coast 
of  America  at  or  north  of  the  line — though  in  India  the  fever  sel 
dom,  if  ever,  appears  in  its  legitimate  garb,  there  are  not  wanting 
facts,  of  the  most  unequivocal  character,  to  show  that  yellow  fever 
has  made  its  appearance,  and  prevailed  extensively  and  fatally  be 
yond  the  southern  limits  mentioned.  Of  course  it  will  not  be  denied 
that  such  has  often  been  the  case  on  the  African  coast.  The  epi 
demics  of  Sierra  Leone,  Ascension,  Boa  Yista,  &c.,  are  there  to  settle 
that  point.  Turn  we  to  the  American  continent,  and  we  shall  find 
that  the  fever  has  prevailed  at  Guayaquil  j1  that  it  has  shown  itself  at 
Callao;2  and  that  it  has  not  spared  Montevideo.3  Nor  should  it  be 
forgotten,  that  the  very  first  epidemic  of  yellow  fever  of  which  we 
have  the  records,  occurred  in  the  southern  hemisphere — at  Olinda, 
in  Brazil — where  it  is  said  to  have  exercised  its  baneful  effects 
from  1687  to  169-i;4  and,  agreeably  to  the  fanciful  notions  of  the 
importationists,  to  have  been  communicated  to  vessels  from  Siam, 

1  De  la  Condamine,  Voyage  a  1'Equateur,  Paris,  1751,  iv.     Ulloa,  Voyage  Historique 
de  1'Amcrique  Meridionale,  ii.  149  (1752). 

2  Leblond,  Observ.  sur  la  Fievre  Jaune,  200. 

3  Humboldt,  Essai  Politique,  iv.  503,  8v.  ed, 

4  Fcrreyra  da  llosa,  Tratado  unico  da  constitui9ao  pestilencial  de  Pernambuco,  em 
Lisboa,  1094. 


184  PNEUMONIA    AND 

which  in  their  turn  introduced  it  into  Martinique.  I  am  aware 
that  doubts  may  be  entertained  as  to  the  real  icterode  nature  of 
that  fever,  and  I  myself  am  not  free  from  misgivings  on  the  sub 
ject;  but,  admitting  it  to  have  been  nothing  more  than  a  severe 
form  of  bilious  remittent  fever  with  typhoid  tendencies,  some  of 
the  cases  observed  on  that  memorable  occasion  presented  the  de 
cided  characters  of  true  yellow  fever,  thereby  showing  the  possi 
bility  of  the  occurrence  in  question.  Since  then,  we  learn  from 
Sigaud  that,  during  his  residence  at  Eio,  he  saw  five  well-marked 
cases  of  the  disease.1  Add  to  this  that  the  events  of  the  last  few 
years  are  of  a  nature  to  convince  the  most  skeptical  of  the  possi 
bility  of  true  yellow  fever  occurring  in  that  hemisphere;  for  no  one 
is  ignorant  of  the  fact  that  the  fever  broke  out  at  Bahia,  in  Brazil, 
and  soon  after  at  Bio  Janeiro,  where  it  pursued  the  epidemic  course 
it  pursues  everywhere. 

But  these  facts,  to  say  nothing  of  the  circumstance  that  the  dis 
ease  observed  by  Fontana2  and  others  on  the  East  India  coast,  pre 
sented  the  characteristic  marks  of  yellow  fever,  will  be  sufficient  to 
disprove  the  statements  referred  to,  and  to  convince  us  that  the 
same  causes  which  occasion  the  disease  on  one  side  of  the  line  may 
do  so  equally  well  on  the  other.  If,  therefore,  we  find  the  disease 
less  apt  to  prevail  in  some  places  than  in  others,  and  if  a  like 
exemption  as  regards  the  other  forms  of  malarial  fevers  is  noted  in 
various  localities,  we  are  not  from  that  circumstance  warranted  in 
denying  the  febriferous  power  of  malaria,  for,  on  examination,  it 
will  be  found  to  arise  from  the  operation  of  well-known  influencing 
agencies. 

The  exemption  may  le  explained  in  various  icays. — Sometimes  it  is 
due  to  the  high  elevation  above  the  level  of  the  sea  of  the  place  so 
exempted.  At  another  time,  the  effect  is  attributable  to  the  ab 
sence  of  a  sufficiently  high  and  long-continued  atmospheric  heat. 
In  other  instances,  the  circumstance  is  due  to  a  very  perfect  and 
constant  ventilation,  and  a  very  rarefied  and  pure  character  of 
atmosphere.  In  some  instances,  again,  it  may  be  explained  by  the 
peculiar  geological  character  of  the  soil ;  the  quantity  and  the  qua 
lity  of  the  surface-water ;  or  the  proportion  of  sulphates  the  latter 

1  Du  Climat  ct  ties  Maladies  du  Brezil,  258. 

2  DCS  maladies  qui  attaquent  les  Europdens  dans  les  pays  cliauds,  72-3. 


AUTUMNAL    FEVERS.  185 

contains  in  solution.  Sometimes,  also,  it  is  due  to  the  rapidity  of 
the  river  currents,  the  excessive  and  rapid  dryness  of  the  atmosphere 
during  the  hot  season,  the  existence  and  extensive  prevalence  of 
refreshing  and  purifying  winds,  and  often  to  the  degree  of  desicca 
tion  the  surface  has  attained  by  natural  or  artificial  means,  the 
degree  of  cultivation  to  which  it  has  been  carried,  and  other  agencies 
of  like  import,  as  well  as  by  the  extent  to  which  it  is  sheltered, 
by  rich  foliage  and  other  means,  from  the  action  of  the  sun.  So 
far  as  ships  are  concerned,  the  freedom  from  fever  will  often  be 
found  ascribable  to  the  latitude  in  which  they  may  be  navigating, 
to  the  early  period  of  the  year  in  which  they  may  be  at  sea,  or 
otherwise  employed ;  or,  to  the  absence  of  an  epidemic  constitution 
of  atmosphere. 

In  the  examination  of  the  subject,  none  of  these  contingencies 
should  be  overlooked.  Experience  has  shown  that  there  is  an 
altitudinal  range,  varying  in  different  parts  and  according  to  the 
peculiar  form  of  the  disease,  beyond  which,  owing  to  the  greater 
rarefaction  of  the  air,  peculiarity  of  temperature,  or  other  circum 
stances,  the  elimination  of  the  febrile  poison  does  not  take  place, 
or  the  latter  is  rendered  inert;  that  a  certain  range  and  continued 
elevation  of  the  thermometer  is  required  for  its  development ;  and 
that  free  ventilation,  and  strong  unimpeded  currents  of  wind  are 
inimical  to  its  morbid  agency.  Experience  has  shown  in  addition, 
that  while,  as  we  have  seen,  an  argillaceous  soil  is  prone  to  the 
development  of  fever,  a  region  of  primary  formation,  with  a  sandy, 
calcareous,  arid,  and  sterile  soil,  allowing  no  stagnant  water,  and 
containing  only  a  small  proportion  of  organic  remains,  is  usually 
exempt  from  the  disease ;  that,  in  not  a  few  instances,  the  passage 
from  a  fever  to  a  healthy  locality  takes  place  within  circumscribed 
boundaries,  and  is  indicated  by  a  difference  in  the  geological  for 
mation  of  the  soil ;  and  that,  if  exceptions  to  this  occur,  the  ex 
planation  is  easily  found  in  the  fact  that  the  cause  of  the  disease 
has  been  wafted  from  some  pestiferous  region,  to  a  locality  which, 
otherwise,  would  have  remained  unaffected ;  or  in  the  circumstance 
that  the  calcareous  structure  of  the  sickly  spot,  though  naturally 
of  a  kind  not  subject  to  fever,  is  covered  over,  extensively  or  in 
spots,  with  a  more  or  less  thick  coating  of  rich  absorbent  soil, 
possesses  an  argillaceous  substratum,  or  presents  depressions,  in 
which  water  stagnates,  and  the  process  of  decomposition  takes 
place.  Again,  experience  has  shown  that  water  containing  a  small 


186  PNEUMONIA    AND 

amount  of  sulphates,  is  less  injurious  to  health,  and  less  prone  to 
favour  the  formation  of  malaria,  than  that  which  is  richer  in  those 
materials ;  while  on  examination,  it  is  found  that  the  vegetable 
matter  contained  in  peat  moss  is  subcarbonized,  and  necessarily 
unsusceptible  of  decomposition ;  that  such  moss,  as  already  stated, 
is  known  to  possess  peculiar  antiseptic  qualities,  which,  by  impart 
ing  to  it  the  power  of  preserving  not  only  trees  and  other  vegetable 
but  animal  substances  from  putrefaction,  renders  it  unfit  to  evolve 
the  efficient  cause  of  periodic  fevers. 

See  the  remarkable  contrast  noticed  in  the  relative  prevalence  of 
agues  in  New  England,  New  Brunswick,  and  Nova  Scotia,  on  the 
one  hand,  and  on  the  other,  in  the  region  of  the  great  lakes  on  either 
the  American  or  British  soil.  This  contrast,  resulting  from  the  ab 
sence  of  such  fevers  in  the  former  region,  and  its  great  prevalence 
in  the  latter  finds  no  explanation,  as  Dr.  Forry  well  remarks,  in 
any  difference  of  climate  as  regards  temperature  and  moisture ; 
but  the  solution  must  be  sought  in  the  modification  of  climate 
arising  from  geological  formation  and  the  nature  of  soil.  "  Now, 
as  the  region  of  New  England,  as  far  as  the  St.  Lawrence,  with 
little  exception,  has  a  primitive  formation,  with  a  sandy,  sterile 
soil,  whilst  that  of  the  lakes  consists  of  a  secondary  formation, 
having,  not  urifrequently,  an  alluvial  superstratum,  composed  of 
a  rich  vegetable  mould  from  three  to  six  feet  deep,  it  is  not  diffi 
cult  to  deduce  the  correct  inference.  In  the  former,  the  geologi 
cal  structure  is  destitute  of  organic  remains,  and  the  little  con 
tained  in  the  sandy  soil  does  not  find  enough  moisture  to  induce 
the  necessary  chemical  action ;  while  in  the  latter,  not  only  is  the 
geological  formation  of  secondary  origin,  but  the  deep,  rich  soil  is 
sufficiently  humid,  when  a  high  temperature  acts  upon  the  organic 
remains  with  which  it  abounds,  for  the  development  of  the  morbid 
poison  called  malaria."1 

The  fact  that  some  marshy  surfaces,  which  are  supposed  to 
give  rise  to  fevers  by  means  of  the  exhalations  issuing  from  them, 
prove  completely,  or  to  a  great  extent,  innocuous  in  certain  sea 
sons,  and  even  during  a  succession  of  years,  cannot  be  urged  as 
an  argument  in  favour  of  the  denial  of  the  malarial  cause  of  fever, 
finding,  as  it  does,  a  ready  explanation  in  the  absence,  during  those 
seasons  of  exemption,  of  the  thermometrical  and  hygrometrical 

1  Forry,  Climate  of  the  United  States,  280. 


AUTUMNAL    FEVERS.  187 

conditions,  which  experience  has  taught  us  to  regard  as  essential  to 
the  evolution  of  the  poison,  as  well  as,  often,  in  the  absence  of  that 
peculiar  state  of  atmosphere  to  which  the  name  of  epidemic,  con 
stitution,  or  meteoration  has  been  applied ;  and  the  agency  of  which, 
in  diffusing  and  enhancing  the  virulence  of  the  cause  of  certain 
diseases — explain  it  as  we  may,  and  extraordinary  as  it  may  appear 
— it  would  be  just  as  reasonable  to  doubt,  as  to  doubt  the  existence 
of  those  fevers  themselves. 

Elevation. — In  regard  to  elevation — not  that  to  which  the  cause 
of  fever,  and  of  course  fever  itself  can  be  carried,  for  we  shall  see 
that  much  may  be  done  in  that  way ; — it  is  a  fact  of  common 
notoriety  that  it  exercises  a  marked  influence,"  not  only  on  the  form 
and  type  of  the  disease,  but  even  on  its  very  existence ;  an  influ 
ence  not  very  dissimilar  from  that  which,  as  already  pointed  out,  is 
occasioned  by  geographical  latitude.  If  fevers  decreased  in  frequency 
in  proportion  as  we  proceed  in  a  northern  direction ;  if  at  last  we 
reach  a  latitude  where  they  cease  to  manifest  themselves;  so,  in  like 
manner,  as  we  ascend  from  the  level  of  the  sea,  they  are  found  to 
diminish  in  frequency  till  at  last  we  arrive  at  a  degree  of  elevation 
varying  according  to  many  concomitant  circumstances,  where 
localities  which,  in  lower  regions,  would  be  sure  to  be  more  or  less 
infested  with  malarial  fevers  may  be  visited  and  inhabited  with 
entire  impunity. 

We  have  already  seen  that  the  marshes  on  the  summit  of  the 
Calabrian  Mountains  do  not  possess  febriferous  powers.  In  other 
parts  of  Italy,  though  some  places,  as  Sezza,  Norma,  Sermonetto,  at 
an  elevation  of  from  230  to  300  metres,  are  unhealthy,  Monte  Mario, 
near  Eome,  at  a  height  of  between  130  to  150  metres  (about  495 
feet),  and  Tivoli,  at  one  of  208  metres  (about  690  feet),  are  free 
from  the  fever  which  scourges  the  neighbouring  localities.1  Much, 
of  course,  will  depend  on  the  direction  of  the  wind,  the  mode  of 
exposure,  and  other  local  circumstances.  As  a  general  rule,  accord 
ing  to  Tournon,  when  we  reach  a  height  of  from  120  to  150  metres 
above  the  level  of  the  plain,  we  enter  the  salubrious  zone,2  whatever 
may  be  the  nature  of  the  localities  so  situate.  Monfalcon  (p.  75) 
agrees  with  those  who  fix  the  limits  at  four  or  five  hundred  metres 

1  Tournon,  Etudes  Statistiques  sur  Rome,  i.  209 ;  Julia,  25,  2G ;  Brcyslack,  Voy. 
dans  la  Campanic,  ii. 

2  Tournon,  ibid.  209;  Carriere,  314  (note). 


188  PNEUMONIA    AXD 

—1,167  to  1,667  feet.  The  Italians  are  well  aware  of  this  advan 
tage  of  elevation  ;  for,  according  to  them,  in  ascending,  we  pass 
gradually  from  the  aria  passima  to  the  cativa  ;  thence  to  the  sospetta; 
then  to  the  sufficiente  ;  to  the  buona ;  and,  finally,  to  the  find  o 
ottima. 

The  mountains  of  Corsica,1  of  Tyrol,2  and  of  Switzerland,3  are 
in  like  manner  exempt  from  the  same  diseases,  while  the  valleys 
and  low  lands  are  severely  afflicted ;  and  yet,  in  the  former,  sources 
of  marsh  exhalations  are  not  wanting.  Maroon  Town  and  Phoenix 
Park  (Jamaica),  each  at  a  height  of  2,000  feet,  are  remarkable  for 
healthiness.4  The  inner  Cabrite  and  the  outer  Cabrite — the  first  at 
430  and  the  latter  590  feet  of  elevation — have  also  been  found  very 
healthy.  In  Grenada,  Morne  Cardigan,  500  feet,  and  Kichmond 
Heights  730  feet,  are  not  sickly.5  Mount  Demoulin,  near  Roseau,  in 
the  Island  of  Dominica,  at  an  elevation  of  1,500  feet,  has  been  inva 
riably  free  from  yellow  fever.6  The  same  immunity  has  been 
noticed  in  St.  Domingo,  in  the  mountainous  parts  of  which,  what 
ever  be  the  condition  of  the  soil,  this  disease  does  not  prevail.7  The 
same  fever  has  made  its  appearance,  in  1812,  and  other  occasions, 
on  Brimstone  Hill,  St.  Christopher,  at  an  elevation  of  700  feet,8  and 
four  times  (1817,  1825,  1827,  and  1831)  at  Stoney  Hill,  Jamaica, 
the  height  of  which  is  1,360  feet.9  But  these  are  generally  healthy, 
and  free  from  ordinary  fever.  In  Mexico,  according  to  Humboldt, 
the  farm  of  the  Encero,  the  height  of  which  is  928  metres,  forms 
the  superior  limits  of  the  vomito,10  and  the  same  disease  scarcely 
ever  passes  beyond  the  ridge  of  mountains  that  separate  La  Guayra 
from  the  valley  of  Caraccas.11 

Major  Tullock,  while  remarking  that  mere  elevation  to  a  height 
of  600  or  700  feet,  does  not  secure  a  healthy  position,  as  demon 
strated  by  the  instances  of  Fort  St.  George,  at  Toboga,  of  Morne 
Fortune,  at  St.  Lucia,  and  of  Mount  Bruce,  at  Dominica,  where, 
indeed,  the  results  were  the  reverse  of  salutary,  adds  that  it  is 
proved  beyond  a  doubt  that,  "at  an  elevation  of  2,000  or  2,500  feet, 

1  Heurteloup,  Tr.  de  Giannini,  i.  269  (note). 

2  Zimmerman,  de  1'Expericnce,  i.  10G. 

3  Bosquillon,  Tr.  de  Cullen,  i.  70. 

4  Imray,  Ed.  J.  Ixx.  200  ;  Arnold,  192  ;  Statist.  Kept,  of  Sickness,  &c.  fi3. 

5  Hunter,  307.  6  Imray,  Edinb.  J.  Ixiv.  340  ;  Lind,  224. 

7  Bally,  326,  335  ;   Dalmas,  64,  65 ;   Gilbert,  102. 

8  11.  Jackson,  Sketch,  i.  10.  9  Tullock's  Kept,  59. 

10  Xouvelle  Espagne,  771.  »  Humboldt,  Pers.  Nar.  iii.  392-5. 


AUTUMNAL    FEVEKS.  189 

they  are  likely  to  be  wholly  exempt  from  that  disease,  or  to 
encounter  it  in  so  very  modified  a  form,  that  the  mortality  from  all 
causes  will  not,  on  the  average  of  a  series  of  years,  materially 
exceed  that  to  which  an  equal  number  of  European  troops  would 
be  subject  in  the  capital  of  their  native  country."1  Bally  also  gives 
to  the  yellow  fever  an  analogous  altitudinal  limit.2 

In  this  county,  the  yellow  fever  is  never  known  to  prevail  in 
very  high  situations,  whatever  may  be  the  condition  of  the  localities. 
As  regards  ordinary  autumnal  fever,  the  exemption  is  noticed  from 
one  end  of  the  continent  to  the  other.  The  city  of  Mexico,  and 
the  surrounding  country,  is  never  visited  by  the  fever  which 
scourges  the  land  near  the  level  of  the  sea.  "  The  inhabitants 
among  the  sources  of  the  Kenawba  and  Tennessee  Rivers,  on  the 
Appalachian  Mountains,  at  a  medium  elevation  of  nearly  three 
thousand  feet,  are  almost  exempt,  while  those  who  occupy  the 
valleys  under  the  same  parallels  are  affected  ;  and  farther  north, 
at  half  that  elevation,  where  the  Alleghany  and  Genesee  Rivers 
have  their  sources,  the  disease  is  almost  unknown,  while  on  the 
shores  of  Lake  Ontario,  directly  north,  it  prevails.  Finally,  the 
constantly  increasing  elevation  of  the  desert  to  the  west  of  the 
Mississippi  is,  no  doubt,  one  cause  of  the  disappearance  of  the 
fever  under  the  same  parallels  in  which  it  prevails  on  the  banks 
of  that  river."3 

Assilini,  in  his  treatise  on  the  Plague,  remarks  that,  during  all  the 
epidemic  fevers,  and  even  the  most  dreadful  plagues,  there  have 
been,  in  those  cities  and  provinces  where  such  diseases  were  raging, 
some  healthy  spots.  "The  citadel  of  Cairo  presents,"  he  states,  "one 
example.  It  has  been  observed  that  the  inhabitants  of  this  fort 
and  its  environs  have  always  escaped  from  the  plague,  even  from 
that  of  the  year  1791.  If  the  inhabitants  of  this  fort,  in  spite  of 
their  daily  intercourse  with  those  of  the  city,  were  preserved  from 
this  disease,  it  must  be  because  the  damp  and  infected  air  which 
had  destroyed  the  health  of  the  inhabitants  of  lower  Cairo,  had  not 
sufficient  elevation  to  reach  to  the  highest  part  of  the  citadel  and 
its  environs,  and  consequently  could  not  impair  the  health  of  those 
who  lived  there."  (Pp.  58-9.)  Just  as  probable  is  it  that  the  exha 
lations  giving  rise  to  that  form  of  fever  cannot  be  eliminated  in 
that  high  and  salubrious  situation.  In  the  year  1835,  when  the 

1   Oj).  cit.  103.  2  Typhus  d'Amerique,  025,  6.  3  Drake,  715. 


190  PNEUMONIA    AND 

disease  committed  such  ravages  in  the  same  city,  the  citadel  was 
again  preserved,  as  well  also  as  the  village  of  Loumeldik,  the  situa 
tion  of  which  is  sufficiently  high  to  overlook  the  whole  Peninsula.1 
As  regards  the  cause  of  the  diminution  and  cessation  of  iniasmal 

O 

fevers  at  certain  degrees  of  terrestrial  altitude,  it  will  be  unnecessary 
to  enter  at  any  length  in  this  place.  The  effect  may  be  due  in 
some  measure  to  a  diminished  atmospheric  pressure.  But  many 
circumstances  induce  the  belief  that  the  explanation  must  be  sought 
principally  in  the  diminished  or  low  temperature  which  forms  a 
characteristic  of  high  localities;  for  it  is  a  well-ascertained  fact 
that,  except  in  cases  where  the  soil  expands  into  extensive  plains, 
and  the  irradiation  of  caloric  which  ensues  counterbalances  the 
cold  incident  to  such  positions,  the  elevation  of  the  soil  is  invari 
ably  attended  by  a  diminution  of  temperature.  It  has  been  com 
puted  that  a  perpendicular  elevation  of  from  three  hundred  to  four 
hundred  feet  produces  a  decrease  of  heat  equal  to  that  attendant  on 
an  approach  of  one  or  two  degrees  toward  the  poles.  Fuster,  in  his 
highly  interesting  work  on  the  Diseases  of  France,  calls  attention  to 
the  fact  that,  under  the  line,  a  degree  of  cold  is  generally  found 
to  correspond  to  an  elevation  of  219  metres  or  730  feet ;  in  the 
temperate  zone,  to  174  metres  or  580  feet;  in  winter,  to  70  metres 
or  233  J  feet  less  than  in  summer;  and  at  seven  o'clock  of  the  morn 
ing  to  60  metres  or  200  feet  less  than  at  five  o'clock  of  the  afternoon. 
In  Paris,  during  the  hot  season,  when  the  ground  is  nearly  as  much 
heated  as  it  is  in  tropical  regions,  it  was  ascertained  by  Gay-Lussac, 
at  the  time  of  his  aerostatic  ascension,  that  at  a  height  of  7,000 
metres,  or  23,333J  feet,  a  degree  of  cold  corresponded  to  an  eleva 
tion  of  only  174  metres  or  500  feet.2 

Supposing  these  statements  to  be  correct,  it  follows,  as  M.  Boudin 
remarks,  that,  at  the  46th  degree  of  N.  latitude,  an  elevation  of 
2,000  metres  or  6, 6  6  6f  feet,  would  give  us  the  temperature  of  Lapo- 
nia.3  With  this  before  us,  we  can  understand  that  febrile  complaints, 
which  are  found  to  diminish  in  point  of  frequency  as  we  proceed  in  a 
northerly  direction,  and  finally  disappear  when  we  reach  a  certain 
point,  will  equally  cease  to  exist  at  a  given  height  above  the  level 
of  the  sea. 

1  Clot  Bey,  Do  la  Pcstc,  223  ;  Braycr,  Neuf  Annees  a  Constantinople,  i.  357. 

2  Fuster,  DCS  maladies  de  la  France  dans  leurs  rapports  avec  les  saisons,  &c.  33. 

3  Op.  cit.  35. 


AUTUMNAL    FEVERS.  191 

This  will  appear  the  more  natural  when  we  take  into  considera 
tion  the  effect  of  temperature  on  the  production  and  dissemination 
of  these  complaints,  for,  as  Dr.  Forry  has  well  remarked,  the  meteor 
ology  of  heat  is  intimately  connected  with  the  laws  of  malarial  dis 
eases  in  the  relation  of  cause  and  effect.1 

Degree  of  heat. — Experience  teaches  us  that,  although  heat  alone 
cannot  be  viewed  as  the  efficient  cause  of  autumnal  or  periodic 
fevers,  a  certain  range  and  permanence  of  elevation  of  temperature 
are  necessary  to  insure  the  development  of  the  disease  ;  and  that, 
unless  this  obtains,  the  latter  does  not  make  its  appearance,  how 
ever  favourable  in  appearance  the  soil  and  localities  may  be  to  the 
production  of  morbid  exhalations.  It  has  already  been  seen  that 
fever  rarely  prevails  in  cold  climates,  and  then  only  during  hot 
weather;  that  in  temperate  latitudes  it  never  shows  itself  in  the 
winter  season,  but  breaks  out  towards  the  middle  of  summer ;  that 
a  temperature  of  sixty  degrees  is  necessary  for  its  manifestation; 
that  it  will  not  prevail  as  an  epidemic  where  the  temperature  of 
that  season  falls  below  65°,  and  that  it  disappears  on  the  accession 
of  frost.2  The  necessity  of  a  still  higher  temperature,  continued 
during  a  certain  time,  has  been  found  requisite  to  insure  the  pro 
duction  of  true  yellow  fever ;  for,  whatever  be  the  condition  of  the 
localities  where  it  generally  breaks  out  and  prevails,  the  occurrence 
fails  unless  the  thermometer  marks  a  high  degree  of  heat,  and  con 
tinues  to  give  a  certain  average  during  weeks  or  months.  We  all 
know  the  average  summer  temperature  of  the  tropics — the  proper 
soil  of  the  disease.  Nowhere,  whether  in  Africa,  the  West  Indies,  or 
on  the  South  American  coast,  does  it  fall  under  80°.  In  our  Southern 
States,  where  the  winter  season  is  characterized  by  cool  weather,  the 
summer  heat  approaches  to  that  of  tropical  regions ;  and  when  the 
fever,  which,  as  is  known,  is  not  there  of  annual  occurrence,  breaks 
out,  it  does  so  generally  in  seasons  when  the  range  of  the  thermo 
meter  equals  that  of  the  West  Indies  and  Vera  Cruz.  Such  has  been 
the  case  at  New  Orleans,  Mobile,  Natchez,  Charleston,  and  Savannah.3 

1  Climate  of  U.  S.  277.  ,     2  Drake,  715. 

3  Gros,  5  ;  Thomas,  62,  78,  109  ;  Barton,  Fev.  of  N.  0.  in  1833,  pp.  4,  5 ;  Baxter,  Med. 
Repository,  xxi.  3;  Kept,  on  Fever  at  N.  0.  in  1819,  6,  ib.  for  1839,  Journ.  of  Med. 
Soc.  156;  ib.  for  Fcv.  of  1820,  for  4;  Shecut  Med.  Essay,  77,  93,  103;  Tooley,  Fever 
of  Natchez,  in  1823,  p.  7 ;  Giraruin,  51  ;  Merrill,  N.  A.  J.  ii.  237,  ib.  Med.  and  Phys. 
Journ.  ix.  233;  Monnett,  11,  35;  Chabert,  23:  Perlee,  Med.  and  Phys.  J.  iii.  17; 


192  PNEUMONIA    AND 

Nor  is  this  less  the  case  in  our  Middle  States,  where  the  summer 
temperature  likewise  approximates  closely  to  that  of  the  torrid 
zone,  for  there  the  fever  has  scarcely  ever  appeared,  unless  the 
mean  temperature  has  reached  or  approached  to  80°.  This  has  been 
observed  at  Norfolk,  Baltimore,  New  York,  Providence,  and  Bos 
ton.  It  was  also  early  pointed  out  in  this  city,  and  has  been  noticed 
in  all  the  epidemics  that  have  prevailed  here  from  1699,  to  the  pre 
sent  year.  All  this  the  reader  will  easily  find  by  referring  to  the 
writings  of  Valentin,1  Whitehead  and  Selden,2  Archer,3  Dal  mas,4 
Miller,5  Seaman,6  Bayley,7  Townsend,8  Drysdale,9  Wheaton,10 
Brown,11  Cadwallader  Evans,12  Caldwell,13  Deveze,14  Chapman,15 
Folwell,16  Ffirth,17  Bush,18  and  others.19  Sir  Gilbert  Blane  has 
called  attention  to  the  same  fact,  in  relation  to  the  yellow  fever  of 
Europe,20  and  his  observations  are  fully  confirmed  by  those  of  every 
writer  on  the  epidemics  of  Cadiz,  Barcelona,  Gibraltar,  Leghorn, 
Xeres,  Seville,  Carthagena,  Marseilles,  &c.,  where  the  appearance 
and  prevalence  of  the  fever  has,  as  elsewhere,  invariably  been  asso 
ciated  with  a  mean  temperature,  in  every  way  equal  to  that  observed 
during  sickly  seasons  within  the  tropics.21 

Cartwright,  Mcd.  Recorder,  ix.  G  ;  Dickson,  Med.  and  Phys.  J.  iii.  251  ;  ib.  Eclectic 
J.  iv.  112;  Simon's  Address,  3 ;  ib.  Kept.  10;  Chalmers,  Climate  of  S.  C.  i.  164 ;  Moul- 
trie,  French  Translation,  8  ;  Ramsay,  Hist,  of  S.  C.  ii.  83  ;  Lining,  Edinb.  Essays,  ii. 
409;  Dupre*,  Am.  J.  (N.  S.)  ii.  382  ;  Waring,  20;  Tucker,  Barton's  J.  ii.  22  ;  Fenner, 
N.  0.  J.  Sept.  1848,  p.  194. 

1  Fievre  Jaune,  85,  6.  2  Med.  Repos.  iv.  129. 

3  Med.  Recorder,  v.  61.  4  Fievre  Jaune,  30,  38. 

5  Works,  118,  110,  433.  6  Webster's  Collection,  1,  2. 

7  Fever  of  N.  Y.  in  1795,  p.  124.  8  Fever  of  N.  Y.  in  1822,  p.  259. 

9  Med.  Museum,  i.  31.  )0  Med.  Repos.  x.  329. 

11  Med.  Repos.  ii.  360,  467;  Treatise  on  Fever  of  Boston,  in  1798,  p.  26. 

12  Ecclect.  Repertory,  vii.  425 ;  and  Med.  Recorder,  i.  139. 

13  Med.  Mem.  (1826),  87.  14   Op.  cit.  116. 

15  Med.  and  Phys.  Journ.  viii.  356.  16  Fev.  of  Phila.  in  1798,  pp.   13-22;   ib. 

1797,  p.  48. 

17  Treatise  on  Mai.  Fev.  21,  2,  3,  4. 

18  Works,  iii.  41,  49,  120. 

19  Emlcn,  N.  A.  Journ.  v.  329;  S.  Jackson,  Fev.  of  1820,  pp.  12,  13;  Watts,  N.Y.  Med. 
Reg.  30;  Carey,  Fever  of  1793,  Meteor.  Tables;   Med.  Repos.  ii.  406;  Curric,  Fever 
of  1793,  p.  15  ;  Smith,  on  Epidemics,  78;  Currie,  Fevers  of  1798,  pp.  2,  4,  5,  37,  8  ; 
Ib.  1798,  p.  29;   Hill,  Fevers  of  Wilmington,  N.  C.  Recorder,  v.  87;   Hardie,  Fever  of 
N.  Y.  in  1798,  end  of  vol. ;  Revere,  Fever  of  Baltimore,  in  1819,  Recorder,  iii.  217. 

20  Dissertations,  ii.  155. 

21  Fellows,  33,  244,  565 ;  Amiel,  in  Johnson,  Trop.  Climates,  250  ;  Pariset,  Fievre  de 
Barcelona,  12,  185;  Robert,  Guide.  Sanit.  110,111,  742;  O'Halloran,  122;  Burnett, 
Fever  of  Mcdit.  2C5 ;   Tomniasini,  sect.   161,  ii.  483;   Bally,  323;   Rayer,  23;   Hock- 


AUTUMNAL   FEVERS.  193 

The  necessity  of  a  high  degree  of  atmospheric  heat  for  the  extri 
cation  or  production  of  the  febrile  cause  out  of  the  materials  from 
which  it  is  usually  found  to  be  obtained,  is  every  day  illustrated  in 
Italy,  for  there,  as  elsewhere,  marshes  or  collections  of  putrescent 
substances,  which  are,  to  all  external  appearances,  in  a  fit  state  to 
evolve  the  poison,  and  even  to  emit  vaporous  effluvia  offensive  to 
the  olfactory  nerves,  remain  innocuous  so  long  as  the  thermometer 
does  not  reach  a  high  point.  "  Thus,"  says  Thouvenelle,  "  in  the 
marshy  lagunes  of  Venice,  during  the  very  low  tides  of  January 
and  February,  the  air  of  the  capital  is  infected  with  an  hepatic  and 
miry  odour  during  ebb-tide.  Nothing  is  seen  at  the  bottom  of 
the  canals  of  the  city,  and  all  around  the  latter,  but  fetid  and  black 
mud.  And  yet,  notwithstanding,  the  health  of  the  inhabitants  was 
not  seen  to  be  affected  in  a  way  to  justify  its  being  attributed  to 
that  cause."1 

"  If  the  temperature,"  says  Dr.  McCormack,  "prove  habitually 
below  80°,  whatever  be  the  exuberance  of  vegetation  or  the  quan 
tity  of  marsh  land,  malaria  is  never  generated.  Malaria  does  not 
subsist  in  the  north  of  England,  nor  in  Scotland,  nor  in  Ireland, 
nor  in  Sweden,  Denmark,  or  Norway,  nor  in  the  colder  parts  of 
Europe,  Asia,  North  and  South  America;  in  fine,  nowhere,  so  long 
as  the  temperature — a  few  degrees  more  or  less — keeps  below  80°. 
Let  it  rise  above  this,  and  thereupon  we  have  malaria,  and  periodic 
fever  in  all  its  forms."  "  If  the  summer  temperature  in  Ireland 
ranged  habitually  from  80°  to  100°,  paludal  fever  would  prove 
even  more  frequent  and  destructive  than  ever  continued  fever  was 
known  to  be.  In  point  of  fact,  some  low-lying  ranges  of  the  uncul 
tivated  land  near  Dublin  and  Belfast,  were  said,  during  hot  sum 
mers,  thirty  or  forty  years  ago,  to  be  productive  of  malaria;  but 
there  is  nothing  of  the  kind  now,  and  intermitting  fever  is  rarely 
witnessed  in  Ireland,  except  in  persons  who  have  been  abroad,  or 
the  poor  serfs  who  go  to  reap  the  harvests  in  the  marshes  of  Essex 
and  Lincolnshire."2 

oux,  110,  111;  Audouard,  44;  Arejula,  132,  133,  134;  Lind,  91;  Berthe,  154,  324; 
Vance  in  Pym,  64 ;  Tullock,  Rep.  on  Sickness  of  Troops  in  Medit,  4,  D.  ;  Caisergue's, 
18,  19;  Pierquin,  Trad,  de  Mem.  &c.  sur  la  F.  Jaune  de  Barcelonne,  40;  Blin,  Trad, 
du  Rapport  sur  la  Mai.  Epid.  &c.  Cadiz,  1800,  p.  4 ;  Doughty,  Observ.  on  Yellow 
Fever,  180,  &c. 

»  Climat  de  1'Italie,  iv.  212. 

2  McCormack  on  Malaria,  Edinb.  Med.  J.  Iv.  372. 

13 


194  PNEUMONIA    AND 

Sheltering  from  the  action  of  the  sun. — Much  of  the  baneful  effects 
of  marshes  and  fresh  surfaces  are  prevented,  especially  in  temperate 
latitudes,  by  their  being  sheltered  from  the  action  of  the  sun.  Mr. 
Fleurian  cle  Bellevue,  in  a  communication  to  the  Academy  of 
Sciences,  shows,  as  the  result  of  his  observations  in  France  and 
southern  Italy,  that  when  marshes  are  well  furnished  with  water, 
and  covered  with  trees  planted  very  close  to  each  other  on  the  banks 
and  causeways,  so  as  to  shelter  them  from  the  action  of  the  sun, 
they  are  as  innocuous  during  summer  as  the  best  soil,  well  dried, 
and  in  full  cultivation.  The  mortality,  in  such  localities,  is  1  to  42, 
or  46 ;  while,  in  other  places,  where  marshes  are  dried,  and  the  soil 
of  these  is  argillaceous,  compact,  horizontal,  and  divested  of  trees — • 
as,  for  example,  in  natural  prairies  that  are  very  dry  during  sum 
mer,  and  on  which  rain  water  remains  stagnant  some  days,  the  loss 
is  1  in  25,  20,  or  even  16.  This  is  conformable  to  the  results  of 
experience  in  this  and  many  other  countries,  where  it  is  found  that 
marshes,  or  new  soil,  which  are  completely  sheltered  from  solar 
heat  by  a  full  growth  of  woods  and  thick  foliage,  may  remain  per 
fectly  or  comparatively  healthy.  It  has  long  been  found,  as  we 
shall  have  occasion  to  show  more  clearly  as  we  proceed,  that  in  the 
midst  of  compact  forests,  the  sun  never  reaches  the  surface,  its  rays 
being  fully  intercepted  by  a  thick  growth  of  trees,  cypress,  juniper, 
magnolia,  reeds,  &c.  In  such  places,  however  apparently  calculated 
they  appear  to  furnish  morbid  exhalations,  intermittents,  nevertheless, 
do  not  prevail.  Dr.  Williamson,  who,  like  many  others,  has  called 
attention  to  this  fact,  remarks  that  families  who  live  in  the  Dismal 
Swamp  of  North  Carolina,  employed  in  making  shingles,  without  a 
perch  of  clear  or  dry  ground,  enjoy  more  health  than  people  who 
live  on  their  new  plantations,  near  the  river  or  swamps.1  That  the 
effect  is  justly  attributable  to  the  cause  mentioned,  may  be  inferred 
from  the  fact  that,  on  the  removal  of  the  means  of  shelter,  fever 
makes  its  appearance.  But  of  this  more  hereafter. 

Free  ventilation. — Again,  experience  has  shown  that  free  ventila 
tion,  and  strong  unimpeded  currents  of  wind,  are  inimical  to  the 
generation  of  malarial  exhalations,  consequently  to  the  production 
of  fever ;  that  where  the  wind  blows  freely  and  strongly,  or  finds 
no  obstacles  from  surrounding  objects,  and  where,  in  consequence, 

1  Hist  of  North  Carolina,  ii.  192. 


AUTUMNAL    FEVERS.  195 

the  air  is  quickly  renewed,  localities  which  otherwise  might  be 
expected  to  be  fruitful  sources  of  fever,  may  be  visited  or  inhabited 
with  impunity,  while  similar  places  become  insalubrious,  if  the  air 
is  stagnant.  "  Calms,"  says  Dr.  Drake,  "  permit  the  exhalations 
from  foul  localities  to  accumulate  in  the  atmosphere  which  rests 
over  them ;  but  all  winds  operate  to  disperse  and  dilute  them  with 
purer  air ;  in  doing  which  they  may  promote  the  salubrity  of  one 
spot  and  diminish  that  of  another."1  It  is  of  daily  observation, 
especially  in  warm  climates,  and  in  hot  seasons  in  temperate  coun 
tries,  or  in  localities  subject  to  periodic  fevers,  that  these  assume  a 
severe  character,  and  even  spread  epidemically  when  the  air  has 
long  been  undisturbed  by  winds  or  thunderstorms.  The  late  Pro 
fessor  Halle,  long  one  of  the  magnates  of  the  Medical  School  of 
Paris,  in  an  able  report  on  the  condition  of  the  River  Bievre,  near 
that  city,  pointed  out  the  fact  that  the  pernicious  effects  of  the  fetid 
exhalations  issuing  from  the  banks  of  that  river,  are  harmless  in 
situations  where  the  atmosphere  circulates  freely  and  is  renewed 
by  strong  and  unimpeded  currents.2  This  injurious  effect  of  a 
stagnant  state  of  the  atmosphere  was  noticed  as  early  as  the 
time  of  Hippocrates,  who  alludes  to  it  in  the  third  book  of  his 
epidemics,  and  has  been  dwelled  upon,  on  just  grounds,  by  many 
\vriters  on  the  fevers  of  the  West  Indies,  of  South  America,  this 
country,  and  Europe.3 

In  many  parts  of  country — India,  and  other  hot  regions,  for 
example — fever  prevails  widely  where  it  should  least  be  expected  ; 
on  high  mountains.  But  these  are  covered  with  lofty  woods,  or 
thick  jungles.  There  the  surface  of  the  earth  is  constantly  strewed, 
particularly  in  autumn,  with  organic  remains,  and  kept  moist  by 
rain  or  dews.  The  lower  stratum  becomes  impregnated  with  effluvia, 

1   Op.  cit.  587.  2  Mem.  do  la  Societe  de  Medecine,  x.  78. 

3  Le  Blond,  7,  16,  19,  10G ;  Clark  on  Long  Voyages,  i.  5;  Imray,  Edinb.  J.  liii. 
92;  Lempriere,  i.  17;  llufz,  31,  32;  Hep.  on  Sickness,  &c.  of  Br.  A.  102;  Merrill, 
Mod.  and  Phys.  J.  ix.  233;  Villerme,  an.  d'Hyg.  xi.  349;  Celle,  Hyg.  des  Pays 
Chauds,  20;  Baglivi,  Op.  Om.  81;  N.  Y.  Med.  Repos.  ii.  403;  Vincent,  Fievre  J.  7; 
Ralph,  Edinb.  Med.-Chir.  Trans,  ii.  55,  GO ;  Copland,  End.  Influences,  Diet.  i.  759, 
Am.  ed. ;  J.  Clark  on  Y.  F.  49,  50,  57;  Monfalcon,  92;  Deveze,  134;  Galliot,  108; 
Van  Swietcn,  v.  160;  Hancock,  78;  Diemerbroeck,  cap.  3,  5;  Caldwell,  Med.  Repos. 
vii.  144,5;  Thouvcnclle,  op.  cit.  i.  180;  Jameson,  Dublin  Med.  J.  N.  S.  xvi.  332; 
Wilson,  Treatise  on  Fevers,  i  79,  Am.  ed. ;  Zimmerman  on  Experience,  ii.  391 ; 
Ainslie,  Smith,  and  Christy,  Fev.  of  Coiinbatori,  60-77;  Rep.  of  London  Gen.  Board 
of  Health  on  Sewer  Water,  &c.  8 ;  Dundas,  Sketches  of  Brazil,  245,  340. 


196  PNEUMONIA    AND 

which  are  seldom  agitated  by  breezes,  or  rarefied  by  the  sun's  rays. 
Dr.  James  Johnson,  who  has  noticed  this,  remarks  that  among  the 
lofty  forests  and  impenetrable  jungles  of  Ceylon,  fever  prevails  ex 
tensively.  "  It  is  under  the  branches  of  these  shrubs,"  (in  Ceylon,) 
says  Lord  Valentin,  "that  the  fatal  jungle  fever  is  probably  gene 
rated.  Not  a  breath  of  air  can  pass  through ;  and  the  confined  ex 
halations  from  black  vegetable  mud,  acquire  a  highly  deleterious 
quality,  affecting  both  the  air  and  the  water."1 

Many  of  the  bays  and  inlets  in  the  West  Indies,  while  they  derive 
their  security,  also  derive  their  unwholesome  air  through  the  agency 
of  the  hills  surrounding  them,  which  gives  them  an  atmosphere  little 
agitated  by  winds,  and  in  which,  consequently,  the  morbid  exhala 
tions  from  the  marshes  which  are  situate  along  their  banks,  may 
well  be  supposed  to  continue  suspended,  accumulate,  concentrated 
by  heat,  and  become  infinitely  more  pernicious.  Dr.  Chisholm, 
among  others,  while  calling  attention  to  this  fact,  and  to  the  cor 
rectness  of  the  explanation,  adduces  several  cases  in  illustration. 
The  French  have,  therefore,  not  inappropriately  denominated  these 
situations  "  lieux  etouffes."2  After  mentioning  that  the  state  of  the 
atmosphere  during  September,  and  the  first  two  weeks  of  October, 
favoured  the  accumulation  of  the  miasmata  in  this  city  during  the 
memorable  epidemic  of  1793,  Dr.  Eush  remarks,  that  the  register 
of  the  weather  shows  how  little  the  air  was  agitated  by  winds 
during  the  above  time.  "  In  vain,"  he  says,  "  were  the  changes  in 
the  moon  expected  to  alter  the  state  of  the  air.  The  light  of  the 
morning  mocked  the  hopes  that  were  raised  by  "a  cloudy  sky  in 
the  evening."  He  very  truly  observes  that,  "  however  inoffensive 
uniform  heat,  when  agitated  by  gentle  breezes  may  be,  there  is  no 
record  of  a  dry,  warm,  and  stagnating  air  having  existed  for  a 
length  of  time  without  producing  disease."3 

Indeed,  all  regular  and  fresh  currents  of  air  have  the  effect  of 
sustaining  the  healthiness  of  malarious  localities,  which,  in  their 
absence,  would  be  more  or  less  the  seat  of  febrile  complaints.  In 
this  country,  cases  in  point  might  be  gathered  without  the  least 
difficulty  as  regards  common  periodic  fever ;  and  every  physician 
among  us  knows  full  well — for  the  fact  is  proverbial — that  the 
yellow  fever  usually  breaks  out  and  is  most  rife  in  places  noted  for 

1  Travels,  ii. 

2  Manual  of  the  Climate,  &c.  of  Tropical  Countries,  &c.  20. 

3  Works,  iii.  86,  87. 


AUTUMNAL    FEVERS.  197 

want  of  due  ventilation,  while  it  requires  but  a  slight  acquaintance 
with  medical  literature  to  know,  that  the  same  observation  has 
been  made  in  respect  to  this  disease  everywhere,  and  that  a  similar 
remark  is  applicable  to  the  oriental  plague.  In  all  places,  they  pre 
vail  and  are  most  rife  and  malignant  in  narrow,  close  streets  and 
alleys,  and  the  poisons  to  which  they  are  due,  if  formed,  are  soon 
dissipated  and  rendered  inert  in  open  and  well-aired  situations. 

It  may  be  affirmed,  without  much  fear  of  error,  that  it  is  through 
the  agency  of  the  trade-wind  alone,  which  blows  almost  constantly 
from  east  to  west,  that  the  greater  part  of  the  West  Indies  is  ren 
dered  habitable.  When  this  purifying  influence  is  withheld,  either 
through  the  circumstances  of  season,  or  when  it  cannot  be  made  to 
sweep  the  land  on  account  of  the  intervention  of  high  hills,  as  is 
the  case  on  the  leeward  shore  of  a  portion  of  Gruadaloupe,  Mar 
tinique,  and  other  islands,  the  consequences  are  most  fatal.1  Every 
one  must  know  that,  in  tropical  regions  generally,  localities  situate 
in  the  midst  of  extensive  forests  and  deep  valleys,  are,  in  general, 
very  unhealthy.  In  the  woods,  the  wind  is  felt  only  by  the  tops 
of  the  trees,  and  it  not  unfrequently  happens  that,  while  the  former 
blows  with  sufficient  violence  to  break  the  upper  parts  of  heavy 
trees,  scarcely  a  breath  of  air  is  felt  on  the  surface  below.  "  We 
cannot  form  an  idea,"  says  M.  Celle,2  "  of  the  fetid  odour  which 
exhales  everywhere  in  some  of  those  extensive  and  damp  forests. 
Scarcely  can  the  sun  force  its  way  through  the  thick  foliage;  and, 
when  it  chances  to  shine  through  some  opening,  the  luminous 
column  is  almost  opaque  from  the  large  admixture  of  vapour  and 
miasmatic  effluvia  with  the  atmospheric  air.  At  night,  the  exhala 
tions  increase,  and  combine  with  those  of  the  preceding  day ;  for 
the  wind  here  never  replaces  the  mephitic  by  a  pure  air.  In  the 
hot  season  of  tropical  regions  the  exhalations  attain  the  maximum 
of  intensity.  In  this  season,  too,  we  find  the  foliage  thickest,  and 
best  calculated  to  prevent  the  free  passage  of  the  wind.  Hence,  the 
inhabitants  of  the  forests  are  then  annually  decimated  by  malarial 
fevers.  The  same  thing  occurs  in  deep  valleys,  where  the  winds 
do  not  penetrate  beyond  the  superior  strata  of  the  atmosphere,  and 
cannot,  therefore,  renew  the  inferior  ones.  Nothing  but  violent 
storms,  accompanied  by  heavy  rains,  can  disturb  and  renew  the 

1  Ferguson,  Notes  and  Recollections,  201. 

2  Hygiene  Pratique  des  Pays  Chauds,  20-23. 


198    '  PNEUMONIA    AND 

heavy  and  impure  atmosphere.  Hence,  the  soil  of  the  valleys, 
when  not  marshy,  is  healthier  in  the  rainy  and  stormy  season  than 
in  April,  May,  and  June,  when  the  predominant  winds  of  the  sea 
son  begin  to  decline  in  force,  and  the  air  becomes  cloudy  and  calm. 
As  the  counterpart  of  this,  I  might  call  attention  to  the  complete 
or  comparative  innocuousness  of  marshy  localities  exposed  to  fre 
quent  and  strong  currents  of  air ;  and  also  to  the  circumstance  that 
the  exemption  from  fever  of  elevated  positions  appears  evidently 
due,  in  great  measure,  to  the  free  and  unimpeded  ventilation  which 
there  prevails.  But  this  would  lead  us  too  far. 

Humidity  of  the  soil. — After  all  that  has  been  said  in  the  preced 
ing  pages  relative  to  the  share  of  agency  exercised  by  terrestrial 
humidity  in  the  production  of  autumnal  fever;  of  the  absence  of 
these  when  the  earth  and  the  dead  organic  substances  by  which  it 
may  happen  to  be  covered  is  completely  and  thoroughly  dried ;  of 
the  outbreak  of  sickness  on  the  reoccurrence  of  rain,  or  of  a  tempo 
rary  overflow,  by  which  a  certain  degree  of  moisture  is  furnished  ; 
and  of  the  absence  or  cessation  of  the  disease  where  the  moisture 
is — from  what  cause  soever — in  excess,  it  is  unnecessary  to  point 
out,  in  any  detail,  the  influence  which  the  quantity  of  surface  water 
exercises  in  modifying  the  degree  of  unhealthiness  of  marshy  sur 
faces,  and  regular  morasses  or  swamps.  Enough  has  been  adduced 
to  show  that  the  innocuousness  of  these,  on  which  the  opponents  of 
malaria  have  dwelt  with  so  much  complacency,  is  sometimes  due 
to  the  circumstance  that  such  localities  are  so  desiccated  as  no 
longer  to  be  the  source  of  morbid  exhalation;  and  much  more  fre 
quently  to  their  being  deluged  with  water,  and  so  completely 
covered  over  that  the  organic  matters  subject  to  decomposition  are 
thoroughly  soaked,  or  effectually  shielded  from  the  action  of  the 
sun.  Some  marshes  are  often,  or  even  generally  in  that  condition. 
Others  cease  to  be  the  source  of  infection  after  heavy  showers  of 
rain,  or  during  the  height  of  the  rainy  season,  or  immediately  after 
a  freshet ;  and  examples  are  not  wanting,  in  this  country  and  else 
where,  to  show  that  marshy  surfaces  that  are  periodically  covered 
under  the  influence  of  the  rise  and  fall  of  the  tides,  are  seldom  the 
source  of  febrile  exhalations. 

The  foregoing  facts  will  go  far  to  account  for  the  circumstance  of 
the  poison  contended  for  not  being  generated,  or  if  generated  not 
being  detrimental  to  salubrity  under  all  conditions  of  soil,  tempera- 


AUTUMNAL    FEVERS.  199 

ture,  &c.  They  show  that  the  cause  of  periodic  fevers  requires  for 
its  development,  besides  particular  materials  to  be  acted  upon  by 
external  influences,  and  which  abound  in  certain  geological  forma 
tions  and  soils  of  particular  kinds,  or  which  are  at  times  collected 
on  the  surface  of  the  earth,  accidentally  or  otherwise,  a  certain  de 
gree  and  continuance  of  atmospheric  heat,  and  a  certain  amount  of 
terrestrial  humidity — neither  too  much  nor  too  little ;  a  complete 
saturation  and  complete  desiccation  of  the  soil  or  its  contents, 
being  alike  inimical  to  the  manifestation  of  the  effects  to  which 
that  cause  gives  origin. 

But  these  facts,  and  many  others  that  precede,  do  more.  They 
lend  a  powerful  support  to  the  opinion  which  ascribes  fever  to  the 
agency  of  a  gaseous  poison ;  for  they  tend  to  connect  this  febrile 
principle  with  the  usual  products  of  the  decomposition  of  organic 
materials,  showing,  as  they  do,  that  this  principle  or  poison  requires 
for  its  generation  the  action  of  the  very  same  agencies  which  are 
necessary  for  that  decomposition.  Precisely  as  takes  place  relative 
to  the  febrile  cause,  ordinary  decomposition  of  organic  matter 
requires  a  more  or  less  prolonged  continuance  and  a  certain  degree 
of  atmospheric  heat.  Equally  necessary  is  it  that  there  should  be 
a  certain  amount  of  moisture.  Similarly  true  is  it  that  an  excess 
of  the  latter  prevents  or  arrests  decomposition ;  and  that  a  total 
absence  of  it  will  have  the  same  effect.  Like  the  febrile  cause,  the 
putrefactive  change  is  promoted  by  a  calm  and  close  state  of  the 
atmosphere,  and  retarded,  prevented,  or  modified  by  free  ventila 
tion  and  elevated  situations.  Now,  when  we  find  the  cause  of 
fever  requiring  for  its  development  the  action  of  the  very  agencies 
which  are  necessary  to  insure  the  development  of  the  gaseous  pro 
ducts  of  decomposition — when  we  find  that  without  these  agencies, 
applied  in  certain  proportions,  neither  those  gaseous  products  nor 
the  efficient  cause  of  fever  will  manifest  themselves;  and  that  in 
all  instances  in  which  the  latter  is  produced,  as  shown  by  the 
occurrence  of  fever,  materials  capable,  when  acted  upon  by  the 
agencies  in  question,  of  giving  rise  to  the  evolvement  of  the  gaseous 
products  of  decomposition — organic  matter  in  various  conditions 
and  states  of  modification  exist ;  and  that  the  total  absence  of  those 
materials — whatsoever  be  the  degree  of  heat,  and  of  terrestrial  and 
atmospheric  moisture — carries  along  with  it  an  absence  of  fever, 
we  can  have  no  reason  to  doubt  the  propriety  of  admitting  that 
the  cause  of  the  disease  bears  a  close  analogy  to  the  aforesaid 


200  PNEUMONIA    AND   AUTUMNAL   FEVERS. 

gaseous  products ;  and  that  if  in  regard  to  the  former,  heat,  hu 
midity,  and  other  agencies,  acting  in  given  proportions  and  in 
concert,  on  animal  or  vegetable  matters,  give  rise  to  the  evolve- 
ment  of  certain  gaseous  substances,  the  febrile  poison,  which  in  like 
manner  requires  for  its  development  the  action  of  the  same  agencies, 
as  also  the  existence  of  kindred  organic  matter,  must  necessarily 
consist  also  of  some  modification  of  a  similar  kind  of  gaseous 
substance. 


CHAPTER    III. 

EXISTENCE  AND   MORBID  AGENCY   OF   MALARIA, 
CONTINUED. 

Occurrences  on  shipboard  prove  the  agency  of  malaria. — The  medical 
literature  of  Europe  and  this  country  abounds  in  facts  of  a  nature 
well  calculated  to  establish,  in  a  satisfactory  manner,  the  existence 
and  morbific  agency  of  malaria ;  and  in  the  presence  of  which  it  is 
difficult  to  conceive  how  any  observing,  reflecting,  and  unbiased 
physician  can  refuse  to  recognize  the  connection  as  cause  and 
effect  between  that  poison  and  fever.  When  they  venture  on  the 
denial  of  that  connection,  the  opponents  of  the  malarial  origin  of 
autumnal  fevers  must  forget,  for  we  cannot  suppose  them  ignorant 
of,  the  eventful  occurrences  on  board  of  the  United  States  ships 
General  Greene,  Macedonia,  Peacock,  Hornet,  and  Enterprise ;  of  the 
French  ships  Ege'rie,  Messager,  and  Euriale ;  and  of  the  English 
vessels  Bann,  Eden,  Eclair,  Iphigenia,  Primrose,  Dasher,  Dart,  Pique, 
Regalia,  Driver,  Rattlesnake,  Childers,  and  Pyramus.  In  each  of 
these,  and  in  many  others  which  could  be  cited,  malignant  fever 
originated  and  prevailed  widely,  and  was  traced  in  a  way  not  to  be 
questioned,  to  miasmata  exhaled  from  the  contents  of  the  holds  or 
from  the  timbers  of  the  vessels.1 

In  most  of  these  cases  the  disease  broke  out  in  vessels  that  had 
sailed  from,  or  were  lying  in  ports,  where,  if  it  ever  had  prevailed  it 
did  not  do  so  at  the  time,  or  had  not  for  some  or  even  many  years 
before  ;  and  when,  therefore,  it  could  not  have  been  derived  through 
the  effect  of  contagion,  or  the  influence  of  common  atmospheric 
causes ;  for  these,  had  they  produced  the  effect  in  question  on  in 
dividuals  on  board,  would  not  probably  have  spared  those  on  shore. 
In  some,  the  fever  appeared  at  sea  during  a  cruise  or  passage,  and 

1  See  an  Essay  on  the  subject  by  the  present  writer,  in  Am.  J.  of  Med.  Sc.  for 
April,  1853. 


202  PNEUMONIA    AND 

far  from  any  contaminated  spot;  and  in  not  a  few  instances,  while 
the  vessels  infected  were  severely  visited  by  the  disease,  others 
situate  close  by,  in  port  or  at  sea,  or  on  the  same  cruising  ground, 
and  which,  had  not  the  cause  been  located  in  the  vessels  themselves, 
would  in  all  probability  have  been  affected  like  the  former,  remained 
uninjured.  That  the  disease  in  the  vessels  mentioned  derived  its 
origin  from  effluvia  evolved  on  board,  and  not  from  ordinary  atmo 
spheric  influences  or  a  contagious  principle,  we  may  infer  from  the 
circumstance  that  none  of  the  sick  who  were  landed  from  vessels  so 
infected  and  received  into  hospital  wards  in  various  places,  were 
found,  in  a  single  instance,  to  communicate  it  to  those  around;  no 
one  from  on  board  carried  the  disease  on  shore,  while  nearly  every 
individual  who  ventured  on  board  sooner  or  later  was  attacked. 
In  many  instances  exposure  to  the  effluvia  issuing  during  the  cleans 
ing  and  purifying  process  from  the  hold,  of  ships  heretofore  un- 
contaminated,  or  very  long  free  from  the  fever,  after  the  crew  had 
been  dismissed,  and  when  no  one  was  left  on  board  to  communicate 
disease,  has  been,  not  in  tropical  and  fever  regions  only,  but  in 
temperate  climates  also,  the  cause  of  the  most  concentrated  and 
fatal  form  of  the  malady;  while  other  individuals,  who  were  placed 
under  the  influence  of  the  same  general  morbid  agencies  as  the 
former,  escaped  the  infection  by  avoiding  such  exposure. 

Whether  the  latter  proceed  from  effluvia  issuing  from  the  bilge- 
water,  the  timber  of  the  ship,  the  filth  of  the  hold,  or  the  cargo,  the 
existence  of  the  cause  within  the  precincts  of  the  ship — particularly 
in  the  hold — is  rendered  evident  not  only  by  the  circumstances 
already  mentioned,  but  by  the  limited  space  and  the  particular  spots 
to  which  it  is  confined  at  the  outset,  or  throughout  the  whole  dura 
tion  of  the  epidemic.  The  disease  (yellow  fever)  usually  or  very 
frequently  makes  its  appearance,  and  is  more  severe,  in  the  vicinity 
of  the  pumps  and  main  hatchway.  This  is  exemplified  by  the  oc 
currences  on  board  of  the  General  Greene,  the  Macedonia,  the  Rattle 
snake,  the  Rainbow,  the  Force,  the  Skipjack,  the  Ferret,  the  Scylla, 
the  Lively,  and  the  Isis,  and  is  nothing  more  than  what  might  have 
been  expected;  for  there  the  keel  is  most  dependent,  the  water 
draining  from  other  parts  is  accumulated,  and  the  heat  is  most 
intense.  Thus,  in  English  frigates,  the  first  cases,  and  the  largest 
rate  of  mortality,  have  in  many  instances  been  found  to  occur  in 
the  berths  of  the  midshipmen  and  marines,  which,  in  such  vessels,  are 
placed  on  each  side  of  the  pumps  and  main  hatchway.  We  are 


AUTUMNAL    FEVERS.  203 

told  by  Dr.  Wilson,  that  the  subsequent  progress  of  the  disease 
depends  on  the  trim  of  the  vessel  and  the  inclination  of  the  keel 
from  the  horizontal  position — the  fever  spreading  in  the  most  de 
pendent  parts.  In  almost  all  cases,  the  disease  prevails  more,  arid 
the  risk  of  infection  is  greater,  in  the  lower  than  in  the  upper  deck. 
It  is  sometimes  confined  to  one  end  or  one  side  of  the  vessel. 
Take  the  following  as  an  illustration. 

"In  the  Rattlesnake,  the  fever  was  first  manifested  near  the  main 
hatchway ;  the  marines  and  the  midshipmen  of  one  berth,  suffered 
its  earliest  and  most  severe  effects.  Afterwards,  it  proceeded  for 
ward  rapidly,  but  pretty  regularly,  till  it  had  affected  almost  the 
entire  ship's  company  ;  but  it  did  not  go  beyond  the  steerage  in  the 
opposite  direction,  no  one  being  attacked  in  the  gun-room  except 
the.  purser,  and  I  have  good  reason  to  conclude  that  in  his  case  it 
was  derived  from  the  shore."  "But  its  local  origin  and  limited 
range  of  action  were  most  strikingly  exemplified  in  the  berths  of 
the  midshipmen,  and  other  officers  of  that  class.  They  were  placed 
exactly  opposite  to  each  other,  with  the  pumps  at  equal  distances 
between  them.  Only  one  gentleman  was  affected  in  the  starboard 
berth,  while  every  member  of  the  larboard  berth  was  laid  up  nearly 
at  the  same  time.  The  hatch  of  the  pump-well  is  opposite  to,  and 
within  three  feet  of  the  larboard  berth.  The  members  of  that  berth 
were  generally  the  junior  officers  of  their  class,  and  were,  therefore, 
it  may  be  said,  most  susceptible  of  the  disease ;  but  when  it  is  re 
membered  how  extensively  it  prevailed,  and  how  indiscriminately 
it  attacked  persons  of  all  ages  and  temperaments  among  the  ship's 
company,  after  every  allowance  is  made  for  the  greater  susceptibility 
of  these  young  gentlemen,  the  exemption  of  the  others,  senior  only 
by  a  few  years,  is  too  striking  and  complete  to  be  accounted  for  by 
their  former  service,  or  by  any  accidents  which  can  reasonably  be 
supposed  to  have  affected  them.  It  can  fairly  be  attributed  only  to 
their  not  having  been  exposed  to  the  cause  of  the  disease  with  the 
same  concentration  of  power,  or  permanence  of  operation,  as  the 
others ;  and  here  the  contiguity  of  the  pump-well  hatch  to  the  lar 
board  berth  cannot  be  overlooked."1 

When  we  bear  in  mind  the  particular  condition  of  the  vessels 
in  which  the  yellow  fever  makes  its  appearance,  as  well  as  the 
thcrmometrical  and  other  influences  in  connection  with  which  it 

1  Wilson,  Memoirs  of  West  Indian  Fevers,  159,  160. 


204  PNEUMONIA    AND 

breaks  out  and  prevails,  and  compare  the  results  of  those  various 
circumstances  with  such  as  are  obtained  on  land  from  kindred  local 
conditions,  under  the  modifying  agency  of  the  same  meteorological 
influences,  we  shall  find  no  valid  reason  for  refusing  to  admit  the 
relationship  as  cause  and  effect  between  the  product  of  the  decom 
position  which  necessarily  ensues  and  the  disease  which,  affecting  only 
individuals  exposed  to  it,  spares  those  who  keep  aloof.  At  the  same 
time,  we  discover  a  satisfactory  explanation  of  the  manner  in  which 
these  results  are  brought  about.  As  the  disease  requires  invariably 
for  its  production  a  long  continuance  of  high  atmospheric  heat,  and 
as  it  is,  on  that  account,  most  generally  encountered  in  tropical,  or 
during  the  hot  season  of  temperate  climates,  we  can  readily  under 
stand  why  it  more  frequently  occurs  on  board  of  ships  in  the  former. 
Besides,  such  vessels  usually  contain  materials  susceptible  of  decom 
position,  and  which,  when  acted  upon  by  the  high  temperature  they 
there  encounter,  are  soon  productive  of  noxious  exhalations.  In  mer 
chant  and  other  ^vessels  engaged  in  the  West  India,  South  American, 
or  African  trades,  the  cargoes  consist  almost  exclusively  of  articles 
susceptible  of  fermentation  or  putrefaction ;  while  the  same  vessels, 
as  well  as  ships  of  war,  are  apt  to  be  ballasted  with  materials  alike 
liable  to  those  injurious  changes,  and  which,  together  with  portions 
of  articles  provided  for  food,  chips  of  wood,  shavings,  and  dirt  of 
all  kinds  that  inevitably  find  their  way — sometimes  in  unaccountable 
quantities — into  the  holds  of  vessels,  where,  meeting  with  more  or 
less  moisture,  supplied  by  leakage,  or  the  water  used  for  purposes 
of  cleansing  or  purification,  or  the  drippings  of  the  casks,  or  other 
sources,  they  form  a  mass  which,  under  the  influence  of  intense 
heat  and  a  still  atmosphere,  becomes  the  source  of  concentrated 
miasmata.  By  one  well  versed  in  all  matters  of  the  kind,  we  are 
reminded  that  it  is  not  always  possible  to  account  for  the  dirt  and 
rubbish  which  may  be  found  in  the  bottom  of  a  ship. 

"  Fragments  of  wood,  vegetable  substances,  and  dirt  of  all  kinds, 
however,  gravitate  by  the  formation  of  the  vessel  towards  the 
kelson  or  limbers ;  where,  by  the  heat  of  the  climate  and  the 
action  of  the  salt-water,  they  rapidly  decay,  and  form  a  blackish 
mud,  not  dissimilar  to  that  observed  among  the  roots  of  mangrove 
thickets  on  the  banks  of  the  rivers  within  the  influence  of  the 
tides ;  it  sometimes  even  acquires  a  consistence  sufficient  to  block 
up  the  passage  of  the  limbers.  In  small  vessels,  with  a  flying  deck, 
there  is  less  difficulty  in  accounting  for  the  presence  of  foreign. 


AUTUMNAL   FEVERS.  205 

matters  in  the  hold ;  dust,  fluids  of  various  kinds,  the  sweepings  and 
scrapings  of  the  decks,  and  a  thousand  other  things,  will  find  their 
way  there,  notwithstanding  the  greatest  care,  both  on  the  part  of 
the  officers  and  men,  although  the  latter,  nevertheless,  are  frequently 
wilfully  careless  in  this  matter."  "In  steam-ships,  the  difficulty  is 
still  greater,  in  consequence  of  the  boilers  and  engines  occupying  a 
large  portion  of  the  floor  of  the  hold,  which  cannot  be  got  at.  All 
this  filth,  in  the  concentrated  state  mentioned,  may,  and  often  does, 
exist  in  vessels,  although  the  decks  and  other  parts  apparent  to  the 
eye  are  clean.  In  them,  the  cause  of  offence,  though  hidden,  is  not 
less  real  than  in  vessels  differently  conditioned,  and  proves  often 
detrimental  to  health  before  it  is  suspected  to  exist.  Of  course,  all 
foul  ships  are  not  necessarily  unhealthy ;  but  those  that  escape  are 
the  exceptions."1 

Nor  is  it  less  worthy  of  remark  that  the  very  timber  of  which 
vessels  are  constructed,  especially  when  green  or  not  perfectly 
seasoned,  may  be,  and  has  not  unfrequently  been,  when  acted  upon 
by  the  high  temperature  of  tropical  climates,  the  source  of  disease 
— an  effect  that  could  not  be  produced  otherwise  than  through  the 
morbid  agency  of  noxious  effluvia  resulting  from  the  action  of  heat 
on  such  materials.  At  any  rate,  such  a  condition  of  vessels  has  not 
unfrequently  been  associated,  in  hot  climates,  with  the  development 
of  the  most  malignant  form  of  the  disease;  and,  judging  from  what 
has  been  noticed  on  land  of  the  effect  of  exhalations  from  kindred 
sources  of  infection,  or  at  sea,  from  the  stowage  of  damp  green 
wood,  we  cannot  err  greatly  when  attributing  the  mischief,  in  the 
instances  in  question,  to  the  decomposition  of  the  ship's  timbers. 
On  this  subject,  the  facts  related  by  Dickson,  Wilson,  Eochoux,  and 
others,  leave  no  doubt,  or,  at  the  very  least,  merit  serious  consider 
ation.  The  unhealthiness  of  ships  built  of  green  timber  has 
been  noticed  from  time  immemorial,  and  it  will  be  found  on  exami 
nation  that  severe  epidemics  have,  on  various  occasions,  been  traced 
to  the  stowage  of  a  quantity  of  green  wood  in  the  hold  of  vessels. 
This  was  strikingly  the  case  in  the  English  war-ship  Regalia,  for  the 
medical  account  of  which  we  are  indebted  to  Dr.  Ferguson,2  and  in 
the  French  brig  Messager,  referred  to  by  Dr.  Rochoux.3 

We  all  know,  also,  how  offensive  the  bilge-water  becomes  from 

1  Bryson,  223.  2  Medico-Chir.  Trans,  viii.  108. 

3  Recherches  sur  les  Diffurentes  Maladies  qu'on  Appelle  Fievre  Jaune,  61. 


206  PNEUMONIA    AND 

admixture  with  the  filth  of  the  vessel ;  or  the  great  tendency  that 
the  water,  which  finds  its  way  by  leakage  or  otherwise  into  the 
hold,  has  of  being  decomposed ;  sometimes  owing  to  its  original 
impure  state,  at  others,  to  its  combination  with  the  fresh-water  pro 
ceeding  from  the  drippings  of  the  casks,  &c.  It  is  not  to  be  denied 
that  such  a  condition  of  the  bilge-water  is  not  necessarily  connected 
with  the  appearance  of  disease  on  board  of  ships ;  cases  having 
been  adduced  in  which  the  foulest  and  most  offensive  water  has 
proved  innocuous ;  while  disease  has  raged  where  the  odour  was 
hardly,  if  at  all,  perceptible.  But  such  cases,  which  find  their  pro 
totypes  on  land,  where  localities  noted  for  filthy  pools  escape,  and 
where  the  appearance  of  malarial  fevers  is  sometimes  connected 
with  an  apparently  pure  condition  of  the  water  partially  covering 
marshy  swamps,  or  with  an  absence  of  mud  or  filth,  are  not  fre 
quently  met  with  in  fever  seasons  and  latitudes.  More  generally 
the  re  verse  takes  place;  and  even  were  this  not  the  case,  the  appear 
ance  of  the  disease  may  still  be  due  to  internal  miasmata  issuing 
from  other  sources  of  infection  existing  on  board  ;  or,  again,  the 
water,  though  completely  or  almost  inodorous,  clear,  and  apparently 
pure,  may  nevertheless  contain  in  solution  those  particles  of 
poisonous  matter  which  produces  the  fever.  Nor  does  it  neces 
sarily  follow,  as  some  writers  seem  to  imagine,1  that  the  healthiness 
of  foul  ships  in  southern  or  other  latitudes  disproves  the  opinion 
of  the  connection  as  cause  and  effect  between  exhalations  from 
sources  of  organic  decomposition  and  fever.  Of  course,  all  foul 
ships  are  not  necessarily  unhealthy — all  vessels  containing  vegetable 
and  other  matters  in  a  state  of  incipient  or  decided  decomposition, 
lying  in  southern  ports  or  navigating  southern  waters,  even  in 
warm  weather,  are  not  all  expected  to  suffer  from  fever.  For, 
besides  that,  in  good  logic,  a  negation  can  go  but  little  way  in 
disproving  the  many  well-authenticated  facts  we  possess,  in  favour  of 
a  different  conclusion,  sources  of  vegetable  and  other  decomposition 
on  board  of  ships,  are  under  the  control  of  some  of  the  same 
agencies,  which,  as  we  have  seen,  modify  the  effects  of  like  sources 
of  contamination  on  land.  They  require,  before  they  can  generate 
fever,  to  be  acted  upon  by  high  atmospherical  heat;  that  this  heat 
should  continue  a  certain  length  of  time ;  that  the  season  should 
be  that  in  which  the  fever  usually  prevails;  and  that  there  should 

1  Memphis  Med.  Recorder,  ii. 


AUTUMNAL    FEVERS.  207 

exist -a  suitable  epidemic  constitution  of  the  atmosphere.  Remove 
all  these  contingencies,  and  foul  ships  will  generally  be  found  to 
remain  healthy.  In  the  contrary  case,  those  that  escape  arc,  as  Dr. 
Bryson  has  remarked,  the  exceptions. 

Be  this  as  it  may,  the  connection  as  cause  and  effect  between 
sources  of  miasmal  effluvia  and  fever,  is  conclusively  established 
by  the  example  of  those  vessels  in  which  the  spread  of  the  yellow 
fever  was  arrested,  even  in  tropical  climates,  or  during  the  hot 
season  of  temperate  regions,  by  a  resort  to  a  thorough  process  of 
expurgation.  In  the  Dart,  Pyrarnus,  Dasher,  and  Regalia,  the 
history  of  which  has  been  referred  to  in  detail  elsewhere,1  the  fever 
was  arrested.  In  reference  to  the  first-named  of  those  vessels,  Dr. 
Dickson  remarks :  "  So  many  people  were  taken  ill,  after  going  on 
board  this  vessel,  lying  guardship  at  Barbadoes,  that  it  was  difficult 
to  account  for  it,  except  on  the  principle  of  contagion,  until  the 
peculiar  construction  of  the  ship,  viz.  her  being  divided  into  com 
partments  below,  so  as  to  prevent  the  circulation  of  air  and  the 
stowage  of  the  water  in  bulk,  were  adverted  to,  and  on  examining 
the  large  tanks  or  cisterns,  their  bottoms  were  found  covered  with 
an  offensive  slimy  mud  or  deposition."2  On  the  removal  of  some 
of  these  causes,  the  knocking  clown  of  the  bulkheads,  and  the 
cleansing  out  of  the  cisterns,  the  fever  was  put  a  stop  to. 

On  opening  the  hold  of  the  Pyramus,  the  effluvia  which  issued 
surpassed  anything  Dr.  Hartle  had  ever  witnessed,  and  affected  every 
one  exposed  to  its  influence.  The  quantity  of  filth  which  was  taken 
out  was  sufficient  to  fill  four  large  mud-boats,  consisting  of  shavings 
mixed  with  coal-tar  and  the  water ;  which,  in  consequence  of  the 
choking  of  the  pumps,  had  accumulated  under  the  limber-planks. 
All  the  cases  Avhich  occurred  during  the  process  of  expurgation 
wrere  easily  traced  to  exposure  to  this  bog ;  and  Dr.  Hartle  very 
justly  refuses  to  refer  the  disease  to  the  influence  of  English  Harbour, 
inasmuch  as  other  ships  of  the  squadron  that  lay  much  longer  there 
escaped  the  infection.  It  may  not  be  amiss  to  remark  that  the  sick 
of  this  ship  were  landed  and  placed  in  the  capstern  of  Antigua 
dock-yard  on  the  15th  of  January ;  that  between  that  day  and  "the 
80th,  only  eighteen  cases  occurred;  but  that  on  the  31st,  six  fresh 
attacks  were  added  to  the  list,  and  the  disease  again  appeared  with 
increased  violence  and  malignity."  Dr.  Hartle  adds:  "This  sudden 

1  Am.  Jouru.  April,  18-53.  2  Kept,  in  Bancroft's  Sequel,  208,  9. 


208  PNEUMONIA    AND 

reappearance  and  violence  of  the  disease  induced  me  to  believe  that 
the  people  had  some  communication  with  the  ship,  which  was  then 
undergoing  a  general  expurgation.  This,  with  a  little  trouble,  I 
ascertained  to  be  the  case."  Changes  were  made  in  the  distribution 
of  the  convalescents  and  the  rest  of  the  crew,  and  the  disease  was 
put  a  stop  to  completely.  The  crew  re-embarked  on  the  14th  of 
March  in  excellent  health,  and  remained  so.1 

On  taking  up  the  limber-boards  of  the  Dasher,  says  Dr.  Hartle, 
"the  noxious  effluvia  surpassed  anything  that  I  had  before  expe 
rienced,  and  it  was  with  difficulty  that  the  blacks,  who  were  accus 
tomed  to  this  work,  could  remain.  The  ship-carpenter,  who  had 
been  constantly  accustomed  to  work  in  the  dock-yard,  and  on  many 
such  occasions,  assured  me  that  he  had  not  before  experienced  so 
putrid  a  smell  from  any  ship's  hold.  Between  the  timbers  there 
was  a  collection  of  carpenters'  shavings,  &c.,  in  great  quantities. 
These  had  so  completely  choked  up  the  limber-holes  that  the  water 
could  not  pass  to  the  well  of  the  pump,  and  lay  stagnant.  The 
vegetable  matter  was,  therefore,  in  a  state  of  decomposition,  and  this, 
acted  on  by  high  atmospheric  temperature,  became  neither  more 
nor  less  than  a  marsh  in  the  centre  of  the  ship."  "  That  the  fever," 
continues  Dr.  Hartle,  "was  generated  on  board,  by  noxious  effluvia 
received  into  crowded  and  badly- ventilated  berths,  is,  I  think,  fully 
proved ;  for  the  moment  the  crew  and  marines  were  removed  from 
the  sphere  of  this  hidden  enemy,  the  disease  ceased."  Nothing  like 
the  most  distant  appearance  of  contagion  could  be  traced;  for  none 
but  those  residing  on  board  the  ship,  or  exposed  to  the  effluvium 
from  her  hold,  prior  to  her  expurgation,  suffered  by  the  fever.2 

That  the  cause  of  the  fever  resided  in  the  hold  of  the  Kegalia,  is 
proved  by  the  fact  that  the  cleansing  of  that  part  proved  particularly 
injurious  to  those  exposed;  and  that,  while  the  fumigation  of  the 
ship  proved  of  no  avail  in  purifying  it,  the  fever  ceased  when  she 
was  completely  cleansed,  and,  with  her  hatchways  closed,  her  whole 
hold  had  been  exposed  to  the  concentrated  heat  of  many  stoves. 
In  the  case  of  the  Trinidad  at  Barbadoes,  mentioned  by  Dr.  James 
Johnson,3  the  fever  disappeared  as  soon  as  the  hold  was  washed  and 
cleansed,  the  dirt,  filth,  and  stagnant  water  removed,  and  scuttles 

1  Facts  and  Observations  in  Refutation  of  Sir  G.  B.  Blanc's  Doctrines  as  to  the  Con 
tagion  of  Yellow  Fever,  by  A.  Musgrave,  Appendix  B.,  Med.  Ch.  Rev.  and  Journ.  iv. 
774. 

2  Musgrave,  op.  cit.  774.  3  Trop.  dim.  164,  1st  ed. 


AUTUMXAL    FEVERS.  209 

cut  for  better  ventilation.  To  this,  let  me  add  that  some  officers,  by 
the  early  adoption  of  proper  hygienic  measures,  particularly  of  those 
calculated  to  insure  cleanliness  and  prevent  the  accumulation  of 
sources  of  impure  exhalations,  have  succeeded  in  guarding  their 
vessels,  under  the  most  unpromising  circumstances,  against  the  de 
velopment  of  fever.  While  other  ships  were  sorely  visited  by  the 
disease,  Captain  Smith,  of  the  British  Navy,  never  had  it  in  those 
under  his  command,  during  long  service  in  the  Mediterranean.  Like 
him,  many  other  commanders  have  preserved  their  crews  by  having 
"the  hold  of  their  vessels  washed  out  daily  by  means  of  plugs,  till 
the  water  came  out  perfectly  clear,  so  that  an  accumulation  of  filth 
could  not  take  place."1 

Here,  then,  we  have  proofs  as  positive  as  can  be  desired; — limita 
tion  of  the  disease  to  the  precincts,  or  to  only  one  part  of  some 
vessel; — infection  by  going  on  board;  —  escape  by  remaining 
aloof; — great  mortality  among  the  crew  or  passengers,  and  im 
munity  among  those  of  other  vessels  close  by ; — the  existence  in  the 
former  of  materials  in  a  state  of  decomposition,  or  of  green  wood; 
and  their  absence  in  the  latter; — the  arrest  of  the  disease  by  the 
adoption  of  a  proper  system  of  expurgation,  and  lastly,  its  preven 
tion  by  proper  purifying  measures.  We  perceive  that  yellow,  or 
malignant  fever — the  disease  produced  on  those  occasions,  and  which 
constitutes  one  of  the  forms  of  autumnal  and  epidemic  pyrexise — • 
is  the  result  of  effluvia;  and  certainly,  if  one  of  the  varieties  of 
these  effluvia  can  give  rise  on  shipboard  to  one  form  of  such  com 
plaints,  and  that  form  too  the  most  formidable,  we  may  justifiably 
infer  that  the  same  form  of  fever,  when  it  breaks  out  on  land, 
does  so  through  the  agency  of  similar  effluvia ;  and,  as  a  natural  con 
sequence,  that  other  and  milder  pyrexial  complaints  must  be  the 
morbid  products  of  causes,  which,  though  not  of  an  identical  are 
of  a  kindred  character. 

The  cause  of  fever  wo/ted  ~by  winds  passing  over  sickly  localities. 
—But  we  are  not  restricted  to  this  inductive  process  for  materials 
with  which  to  establish  or  fortify  the  position  here  assumed  respect 
ing  the  malarial  origin  of  autumnal  fevers.  Facts  for  that  purpose 
may  be  gathered  from  all  parts  of  the  habitable  world,  and  have 
been  recorded  from  the  remotest  period  to  the  present  day,  in  the 
history  of  the  disease. 

1  Lond.  Mod.  Geog.  ix.  890. 

14 


210  PNEUMONIA    AND 

Without  dwelling  anew  on  the  circumstance  that  fever  abounds 
more  or  less  in  places  where  the  soil  is  low,  alluvial,  flat,  humid, 
and  filled  with  organic  matters  in  a  state  of  decomposition ;  and,  on 
the  other  hand,  that  it  is  little,  if  at  all  known,  where  contrary  cha 
racters  prevail,  I  may  call  attention  to  the  fact  that  certain  locali 
ties — rural  districts,  towns  or  cities — which  themselves  do  not  con 
tain  any  of  the  elements  of  unhealthiness,  and,  under  ordinary  cir 
cumstances,  remain  free  from  autumnal  or  periodic  fevers,  become, 
at  times,  the  seat  of  the  latter,  when  so  placed  to  the  leeward  of  infected 
districts  as  to  receive  from  these,  through  the  agency  of  the  wind, 
the  pestiferous  miasmata  evolved  from  their  marshy  surfaces.  Facts, 
indeed,  might  easily  be  accumulated  to  show  that,  in  many  fenny 
portions  of  this  globe,  each  locality  has  its  favourable  and  its  un 
favourable  winds.1  With  the  latter,  fever  abounds ;  with  the  for 
mer,  it  diminishes  or  disappears ;  and  it  is  found  that  this  difference 
depends  on  the  position  of  the  marshy  or  infectious  surface  rela 
tive  to  that  locality,  and  also  on  the  circumstance  that,  in  the  one 
case,  those  winds  pass  over  the  source  of  the  effluvia  before  reach 
ing  the  sickly  place ;  while,  in  the  other,  they  take  a  contrary 
course,  and  leave  the  latter  untouched.  I  might  dwell  on  the  case 
recorded  of  Empedocles,  who,  having  observed  that  the  sterility  of 
the  soil,  and  the  plague  from  which  Sicily  so  frequently  suffered, 
were  caused  by  a  southerly  wind,  which  reached  the  suffering  dis 
trict  through  the  interstices  of  the  neighbouring  mountains,  di 
rected  them  to  be  closed,  and,  by  this  means,  put  a  stop  to  the  ill 
effects  in  question.2  But  it  will  be  more  satisfactory  to  cite  a  few 
better  authenticated  instances  which  have  been  noticed  in  more 
modern  times. 

On  the  west  side  of  the  town  of  Marenne,  in  France,  are  situated 
vast  marshes.  When  the  wind  blows  from  the  north,  north-east, 
or  east — in  other  words,  in  such  a  way  as  to  preserve  the  town 
from  the  miasmata  issuing  from  those  marshes,  fevers  are  rarely 
encountered.  When  reversely,  the  wind  blows  from  the  west, 
south-west,  or  south,  i.  e.  so  as  to  pass  over  those  paludal  surfaces 
before  reaching  the  town,  fevers  make  their  appearance  in  the  latter. 
On  the  contrary,  at  Saint  Agnant,  situate  opposite  to  Marenne,  and 
on  the  other  side  of  the  marshes,  matters  take  a  different  turn. 

1  Melier,  M6m.  do  1'Acad.  de  Mod.  xiii.  671  ;  Jaquot,  18-30,  39,  48. 

2  Leclerc,  Hist,  de  la  Mcd.  93.     Sprengl,  Hist,  de  la  Med.  i.  244. 


AUTUMNAL    FEVERS.  211 

There,  during  the  prevalence  of  the  east  wind,  the  town  becomes 
sickly,  while  it  ceases  to  be  so  when  the  opposite  currents  set  in. 
The  city  of  Rochefort  owes  its  present  unhealthiness  in  the  autumn 
to  the  circumstance  that  the  S.  W.  wind,  which  predominates  at 
that  season,  passes,  before  reaching  it,  over  the  extensive  and  pesti 
ferous  marshes  of  Brouage.1  The  S.  S.  W.  wind,  by  passing  over 
the  basin  of  the  Anthion,  opposite  to  Corne,  in  the  department  of 
Marne  and  Loire — which,  in  1843,  was,  from  a  variety  of  circum 
stances,  in  a  fit  condition  for  the  elimination  of  miasmal  exhalations 
— occasioned  that  year  a  pestiferous  infection  in  all  the  neighbour 
ing  localities  exposed  to  its  influence.2  At  Bayniere,  in  Normandy, 
an  unusual  course  of  N".  W.  winds,  blowing  across  the  marshes, 
and  conspiring  with  a  hot  summer,  caused  very  severe  epidemics 
in  1809  and  1810.3 

The  Yelabrum,  at  Rome,  the  district  of  St.  Peter,  the  surface  ex 
tending  from  the  Tiber  to  the  foot  of  the  Janiculus,  and  the  Trasta- 
vere  generally,  from  the  southern  extremity  of  that  mount  to  the 
dependencies  of  the  Vatican,  are  the  only  unhealthy  spots  of  that 
district,  and  are  evidently  indebted  for  the  fever  to  the  poison 
which,  exhaling  from  the  site  of  the  ancient  city,  reaches  them  with 
facility  through  the  agency  of  the  south  winds.  These  are  unim 
peded  in  their  course  thence  by  hills  or  other  similar  obstacles, 
while  they  find  no  means  of  escape  when  once  they  have  arrived 
there.4  Lancisi,5  Baglivi,6  Rigault  de  1'Isle,7  and  other  writers  may 
be  referred  to,  in  testimony  of  the  unfavourable  influence  of  the 
S.  E.  wind  on  the  salubrity  of  those  parts  of  Rome  which  lie  to  the 
leeward  of  the  aforesaid  pestiferous  region,  and  of  neighbouring 
marshes ;  and  of  the  healthiness  of  other  localities,  differently  situ 
ated.  The  stagnant  water  of  Lake  Aguano  exhales  deleterious 
effluvia,  which  are  wafted  back,  in  a  north-eastern  direction,  by  the 
opposite  wind,  on  to  two  villages,  and  even  to  the  convent  of  Ca- 

1  Mem.  de  la  Soc.  Roy.  de  Med.  viii.  281.     Melier,   Mem.  de  1'Acad.  de  M6d.  xiii. 
671-2. 

2  Gaultier   de   Claubry,  Rapport   sur  les  Epidemics,   &c.   Mem.    deTAcad.  xiii. 
119,120. 

3  Macculloch,  357. 

4  Carriere,  Climat  de  1'Italie,  372;   see  Am.  J.  July,  1851,  p.  163. 

5  De  Nox.  Palud.  Effluv.  lib.  2,  cap.  3.  De  Nativis  Coeli,  Rom.  qualitalibus,  iv.  157-8. 

6  Prac.  Med.  lib.  i.  cap.  xv.     Op.  Om.  80. 

7  See  in  Johnson  Trop.  Cl.  315;  see,  also,  Lind  on  Hot  Climates,  30;  the  same  on 
Seamen,  G7  ;   Monfalcon,  77. 


212  PNEUMONIA    AND 

maldules,  situate  a  league  off,  on  a  high  mountain,  and  there  gives 
rise  to  fever,  from  which  other  localities  of  the  vicinity  are  exempt.1 
In  several  parts  of  Italy,  as  also  in  Corsica,  France,  and  many 
other  places,  chains  of  hills,  free  from  morasses,  but  placed  in  a  line 
with  them,  and  in  the  face  of  a  wind  which  carries  to  them  their 
emanations,  were  entirely  depopulated  and  rendered  uninhabitable. 
"Such  is  the  malignity  of  a  marsh  lying  to  the  south,"  says  Lancisi, 
"that,  although  towns  are  built  upon  the  tops  of  hills,  exhalations 
are  wafted  thither,  with  all  their  mischievous  properties,  by  the 
southern  and  south-western  winds.  Grondolpho  affords  a  fact  in 
full  illustration  of  this,  for  the  Lake  Turnus  lay  formerly  below  it, 
full  to  the  south.  From  this  the  air  was  vitiated,  although  the 
prospect  was  not  injured  at  all.  The  ill.  effects  of  this  were  so 
serious,  that  Pope  Paul  V.  could  correct  them  in  no  other  way 
than  by  draining  the  lake  to  dry  ness.  In  commemoration  of  which, 
the  following  inscription  in  marble  is  to  be  seen  in  front  of  the 
government-house  at  Gondolpho:  "In  the  year  of  our  Lord,  1611, 
Pope  Paul  V.,  finding  the  town  to  be  on  the  decline  from  the 
scarcity  of  water,  and  the  noxious  exhalations  of  Lake  Turnus,  con 
tributed  to  its  health  and  joy  by  bringing  water  hither  from  the 
distance  of  three  miles,  and  by  drying  up  the  lake,  in  the  seventh 
year  of  his  pontificate."2 

The  marshes  of  Mantua,  Ferrara,  Noverra,  Verseuil,  afford  simi 
lar  examples  of  the  effects  of  winds  in  transferring  the  cause  of 
fever  from  one  spot  to  another.  In  Venice,  the  north-east  wind  is 
healthy,  and  blows  the  miasmata  of  the  lagunes  on  the  continent. 
The  opposite  winds,  on  the  contrary,  waft  those  miasmata,  as  well 
as  those  of  the  Lido,  and  of  the  mouths  of  the  rivers  that  open  into 
the  former,  over  the  city,  and  fever,  in  the  exposed  districts,  is  the 
consequence.3  On  the  occurrence  of  an  east  wind  there  is  always 
an  increase  of  febrile  diseases  in  London,  which  is  attributed,  in 
great  measure,  to  the  influence  of  marshes  in  distant  parts.  Marsh 
fever  is  not  unfrequently  noticed  in  the  neighbourhood  of  Tavistock 
Square,  and  other  places  in  the  hollow  of  the  northern  district, 
which  affords  free  access  to  the  deleterious  west  winds.  The  eastern 
side  of  Blackheath  is  invariably  afflicted  with  these  winds,  and  dis- 

1  Valentin,  Voy.  Med.  en  Italic,  45;  Cyclop,  of  Tract,  Mod.  iii.  64;  Monfalcon,  79. 

2  Nox.  Palud.  Effluv.  lib.  i.  cap.  v.  20.     Monfalcon,  79  ;   Brown  in  Cyclop,  of  Pract. 
Med.  iii.  04.     Thouvenelle,  Climat  de  1'Italic,  iv.  1}G3. 

3  Carriere,  459,  403. 


AUTUMNAL    FEVERS.  213 

ease  is  the  consequence.  A  northern  wind,  blowing  over  the  Essex 
marshes,  often  produces  agues  on  the  other  side  of  the  river.  The 
east  wind,  which  blows  from  Essex  towards  London,  invariably 
carries  it  (fever)  on  for  many  miles,  as  all  susceptible  persons  expe 
rience.  At  the  east  end  of  London,  it  reaches  all  through  Finsbury 
division  and  White  Chapel,  and  is  even  brought  at  the  back  of  the 
Strand,  along  the  river.1  It  is  a  well-known  fact,  "that  in  the 
southern  section  of  the  United  States,  where  the  prevailing  winds 
of  summer  and  autumn  are  from  the  south  and  west,  the  dwellers 
on  those  sides  of  marshes,  swamps,  rivers,  and  mill-ponds,  are  often 
in  the  enjoyment  of  good  health,  while  the  people  on  the  opposite 
sides,  although  farther,  perhaps,  from  the  laboratory  of  the  poison, 
are  victims  to  fever."2  At  Eatonton  (Gra.),  some  thirty  years  ago, 
bilious  fever  carried  off  many  inhabitants.  The  disease  was  satis 
factorily  traced  to  a  mill-pond,  about  a  mile  east  of  the  village, 
remarkable  for  its  filth,  and  which,  having  run  dry,  was  exposed  to 
the  summer's  sun.  From  this  point,  the  concentrated  poison  was 
swept,  by  easterly  winds,  to  the  village.  The  village  of  Mount 
Zion,  Hancock  County  (Ga.),  was,  in  like  manner,  severely  afflicted 
by  autumnal  fever.  Just  previous,  an  easterly  wind  prevailed  for 
several  weeks,  which  blew  directly  across  Beaver  Dam  Creek, 
nearly  a  mile  distant,  whose  marshes  had  become  dry  under  the 
autumnal  sun.3  During  the  severe  epidemics  of  1821  and  1822,  in 
this  State,  it  was  observed  "  that  the  persons  residing  on  the  north 
and  west  of  streams  of  water  were  peculiarly  obnoxious  to  attacks, 
while  those  residing  on  the  south  side,  in  the  immediate  vicinity, 
were  comparatively  exempt."  The  explanation  may  be  found  in  the 
fact  that,  for  nearly  two  months  of  that  summer,  the  prevailing- 
winds  blew  from  the  south,  with  some  slight  and  short  excep 
tions.4 

"Since  the  month  of  July,  1843,"  says  M.  Gaultier  de  Claubry, 
in  one  of  his  excellent  reports  on  the  epidemics  of  France,  "  inter 
mittent  fevers,  which  were  originally  sporadic  in  the  commune  of 
Orville-la-Mer,  have  assumed  the  epidemic  character,  and  reached 
every  part  of  the  place,  as  well  the  habitations  of  the  rich  as  those 

1  Edinb.  Rev.  xxxvi.  542.    Second  Hep.  of  the  London  Commissioners,  1848,  p  40. 
Rep.  on  the  Drainage  of  the  Lands  forming  the  Sites  of  Towns,  5.     London,  1852. 

2  Caldwell  on  Malaria,  135. 

3  Pendleton,  Charleston  Med.  J.  vii.  450. 

4  Rep.  of  the  Burks  Co.  Med.  Soc,  in  Tr.  of  Tennsyl.  State  Med.  Soc.  ii.  93. 


214  PNEUMONIA    AND 

of  the  poor.  The  N.  1ST.  E.  wind,  which  has  continually  prevailed, 
by  passing  over  the  pond  (situated  at  some  distance),  has  wafted  the 
paludal  miasmata  which  are  there  formed  into  the  principal  street 
of  Orville,  which  faces  the  source  of  the  infectious  atmosphere."1 

The  east  wind  which  passes  over  the  marshes  of  Echats,  carries 
every  autumn  periodic  fevers,  often  of  a  pernicious  character,  to 
the  banks  of  the  Saone  as  far  as  Trevoux,  at  the  distance  of  two 
leagues  from  the  river.2 

Intermittent  and  bilious  fevers  often  prevail  at  Macuto,  and  at 
Caravalleda  (South  America) ;  and  when,  from  time  to  time,  the  sea 
breeze  is  interrupted  by  a  westerly  wind,  the  little  Bay  of  Coria 
sends  an  air,  loaded  with  putrid  emanations,  towards  the  coast  of 
La  Guayra,  notwithstanding  the  rampart  opposed  by  Cape  Blanco.3 
Again,  the  situation  of  the  Laguna  of  Campoma  (a  grea*  meer,  which 
is  divided,  in  dry  weather,  into  three  basins,  situate  to  the  north 
west  of  Cariaco,  near  the  extremity  of  the  gulf  of  that  name),  ren 
ders  the  north  wind,  which,  blows  frequently  after  sunset,  very 
pernicious  to  the  inhabitants  of  that  little  town.4 

At  the  Naval  Asylum,  near  this  city,  where  fever  is  of  very 
common  occurrence  at  the  usual  season,  one  wing  of  the  building 
is  much  more  frequently  afflicted  by  it  than  the  other,  evidently 
owing  to  the  fact  of  its  being  more  exposed  to  the  S.  W.  wind, 
which  passes  over  the  marshy  banks  of  the  Schuylkill  Kiver. 
Among  several  other  instances  of  the  same  kind  that  could  be  men 
tioned,  I  select  the  following,  for  which  I  am  indebted  to  a  highly 
valued  friend  in  Charleston.  The  hospital,  formerly  at  Fort  John 
son,  was  located  on  the  margin  of  the  marsh  upon  a  high  sandy 
ridge,  with  a  small  depression  or  basin  on  the  western  side  of  it. 
About  three  hundred  to  four  hundred  yards  south-west,  were 
several  ponds  surrounded  by  the  wild  myrtle,  cedars,  swamp  oak, 
and  short-leaf  pine.  When  my  informant  took  medical  charge  of 
the  station,  he  learned  that  his  predecessors  were  of  the  opinion 
that  the  western  half  of  the  hospital  was  unhealthy.  Such  was 
the  report  of  the  day,  and  observations  subsequently  made  con 
firmed  the  opinion  of  those  gentlemen.  For  example,  it  was  found 
that  persons  placed  in  the  western  rooms  were  attacked  with  inter- 

1  Mem.  cle  1'Aoad.  de  Mod.  xiv.  123. 

2  Groffier,  Mem.  sur  I'insalubrit6  de  la  partie  Meridional  e  du  Dept.  de  1'Ain,  19, 
Fodcve,  v.  152. 

3  Humboldt,  Personal  Nar.  iii.  S99,  *  Ibid.  108. 


AUTUMNAL    FEVERS.  215 

mittents,  from  which  some  with  difficulty  recovered,  the  disease 
assuming  all  the  violence  of  what  is  commonly  known  in  Charleston 
as  country  fever.  The  observations  were  made  for  several  seasons, 
and  with  the  same  results.  "The  hospital  was  removed  to  Sullivan 
Island,  and  the  location  occupied  by  private  residences,  which  are 
at  certain  seasons  liable  to  intermittents.  The  season  after  the 
hospital  was  abandoned  by  the  government,  and  before  its  removal, 
it  was  occupied  by  several  families  of  planters  from  the  interior. 
Those  who  inhabited  the  western  half  of  the  building  were  dan 
gerously  ill,  while  the  residents  of  the  eastern  escaped."  "  In 
1845,  a  fearful  epidemic  among  children  at  this  settlement  (diph- 
therite  or  membranous  sore  throat)  made  its  appearance.  In  the 
village  of  Johnsonville,  the  mortality  was  terrible  for  so  small  a 
community ;  while,  on  the  United  States  side  of  this  line,  there 
was  not  a  single  case  of  the  disease  amongst  a  population  of  forty- 
nine  children,  most  of  whom  were  subject  to  every  exposure,  and 
living  almost  entirely  upon  salt  provisions.  This  line  of  malarial 
demarcation  was  well  denned  at  Fort  Johnson,  and  the  boundary 
of  health  and  disease  could  be  narrowed  down  to  a  very  limited 
compass." 

In  an  account  of  the  medical  topography  and  diseases  of  Miami 
County,  Ohio,  Dr.  Volney  Dorsey  remarks:  "The  same  observation 
may  be  made  here  which  is  said  to  hold  good  throughout  the  West, 
that  those  persons  inhabiting  the  eastern  side  of  streams  are  more 
liable  to  miasmatic  fevers  than  those  located  on  the  western  border. 
This,  it  is  believed,  is  attributable  to  the  fact  that  most  of  the 
streams  overflow  their  banks  in  the  winter  and  spring,  and  are 
almost  entirely  dried  up  in  the  summer  and  fall,  and  as  at  this 
season  westerly  winds  prevail,  the  rniasm  produced  by  the  burning 
sun  acting  on  the  decaying  vegetable  matter  along  their  course  is 
driven  on  to  the  eastern  banks.  Many  lofty  and  picturesque 
situations  on  the  eastern  side  of  the  Miami  Kiver  are  thus  rendered 
uninhabitable  from  the  yearly  recurrence  of  autumnal,  inter 
mitting,  and  remitting  fevers."1 

Such  facts  are,  indeed,  familiar  to  our  physicians — to  those  espe 
cially  who  practise  in  rural  districts;  for  they  every  day  find  that, 
during  fever  seasons,  one  side  of  watercourses  is  generally  more 
sickly  than  the  other,  and  that  the  difference  depends  on  the  course 

1  Trans.  Am.  Med.  As.  v.  450. 


21.6  PNEUMONIA    AND 

of  the  wind.  Dr.  Pendleton,  to  whose  essay  on  the  topography  and 
diseases  of  middle  Georgia  I  have  already  several  times  referred, 
informs  us,  that  he  has  frequently,  in  the  course  of  his  practice, 
known  fevers  to  prevail  on  one  side  of  a  creek  for  days  together, 
while  the  other  was  entirely  exempt — a  circumstance,  he  rightly 
thinks,  in  no  way  to  be  accounted  for  but  by  the  drift  of  malaria. 

In  Freetown,  Sierra  Leone,  the  agency  of  the  wind  in  conveying 
the  cause  of  periodic  fevers — remittents  and  inter mittents — is  very 
satisfactorily  demonstrated.  Here,  as  in  most  other  sections  of 
tropical  regions,  these  diseases  become  numerous  and  frequent  after 
the  descent  of  the  first  rain.  At  this  period  the  wind  generally 
blows  from  the  northward  and  eastward,  and  consequently  bears 
from  the  Bullom  shore,  or  the  north  bank  of  the  Mitomba — the 
countless  stagnant  pools  and  extensive  marshy  tracts  which, 
loaded  with  decomposing  vegetable  matter,  have  been  so  graphi 
cally  described  by  Mr.  Boyle — a  large  quantum  of  the  noxious 
vapours  therein  generated.  The  direct  agency  of  the  wind  in  con 
veying  these  vapours  is  established  by  the  fact  that,  at  the 
approach  of  the  dry  season,  when  again  the  formation  of  malaria 
is  active,  the  winds  but  rarely  blow  from  the  swampy  Bullom,  and 
fevers  are  less  frequent  in  their  occurrence  and  decidedly  less  fatal 
in  their  consequences.2 

Trincomalia  (Ceylon) — and  very  many  other  places  might  be 
mentioned — is  never  sickly  while  the  north-east  monsoon  prevails, 
and  does  not  become  so  till  the  south-west  wind  reaches  it  from  the 
opposite  shore  of  the  island,  after  having  passed  over  a  great  extent 
of  low,  wooded,  and  very  unwholesome  country.3 

1  Charleston  Med.  J.  vii.  450. 

2  Boyle,  Tract.  Med.  Hist.  Ace.  of  the  Western  Coast  of  Africa,  124,  120  ;  see  also 
p.  44. 

3  Davy's  account  of  Ceylon,  76,  4to. 

It  not  unfrequcntly  happens  that  the  cause  of  the  disease,  while  wafted  to  a 
considerable  height  above  marshy  surfaces,  and  there  producing  its  usual  effects, 
spares,  to  a  greater  or  less  extent,  individuals  residing  in  the  close  vicinity  of,  arid  on 
a  level  with,  the  source  of  the  infection ;  or  at  least  does  not  affect  them  more  exten 
sively  or  severely  than  the  former.  This  has  been  noticed  in  various  parts  of 
France,  Italy,  this  country,  and  the  West  Indies  (Monfalcon,  p.  80).  Experiments 
made  in  France,  more  than  half  a  century  ago,  leave  no  room  to  doubt  that  the  result 
is  due  to  the  upward  tendency  of  effluvia,  under  the  influence  of  the  wind  ;  and  of 
their  being  arrested  in  their  horizontal  migration  by  the  heights  they  encounter.  In 
the  insalubrious  localities  of  the  Bresse,  white  linen  sheets  were  attached  to  high 
steeples  on  the  most  elevated  hills  of  the  vicinity,  and  an  equal  number  suspended  to 


AUTUMNAL    FEVERS.  217 

Other  instances  of  like  import,  relative  to  the  effect  in  question, 
as  observed  in  Algeria,  Batavia,  South  America,  Africa,  the  West 
Indies,  Borneo,  Spain,  and  this  country,  are  on  record,  and  might 
easily  be  adduced.1  But  these  must  suffice.  "When  taken  in  con 
nection  with  those  instances  which,  though  generally  disbelieved, 
appear,  nevertheless,  to  rest  on  respectable  authority,  of  the  febrile 
cause  being  wafted  in  the  common  atmosphere  to  the  distance  of 
several  miles — even  from  Holland  to  England,  as  believed  by  Mac- 
culloch2  and  others;3  of  ships  receiving  the  infection  at  a  great  dis 
tance  from  land — not  less  than  three  thousand  feet,  according  to  Sir 
Gilbert  Blane;4  and  of  fevers  being  derived,  as  already  stated,  at 
Rochefort,  from  the  marshes  of  Bronage,  situate  four  or  five  miles 
off; — when,  I  say,  the  preceding  instances  are  taken  in  connection 
with  these  facts,  as  also  with  the  circumstances  noticed  in  Europe, 
from  the  frontiers  of  Asia  to  the  other  extremity  of  that  continent, 
though  particularly  in  Italy,  that,  as  the  western  coast  presents  a 
larger  surface  of  infectious  marshes,  so  malarial  fevers,  other  things 
being  equal,  prevail  more  extensively  under  the  influence  of  south 
west  winds  than  of  the  opposite  currents,  they  cannot  but  place  the 
question  of  the  morbific  effect,  at  a  distance,  of  winds  passing  over 
pestiferous  localities,  beyond  the  possibility  of  doubt.  If  we  admit 

poles  ten  or  twelve  feet  high,  placed  in  the  lowest  fields.  After  the  lapse  of  a  certain 
number  of  days  and  nights,  all  these  sheets  were  carefully  examined,  when  it  was 
found  that  the  latter  were  merely  damp ;  while  the  former  exhibited  black,  green, 
yellow,  and  livid  spots.  The  experiment  was  repeated  several  times,  and  at  various 
seasons  of  the  year,  and  always  with  the  same  results.  (Ib.  81.) 

1  Jacquot,  Recherches,  sur  les  causes  des  fievres  a  quinquina,  18,  36,  39,  48;  Lind, 
op.  cit.  113;  Osgood,   29;   Horsefield,  Med.    Museum,  i.   79;  R,   Jackson,  Sketch,  i. 
11  ;  ib.  Outlines,  77  ;  and  Treatise,  412;  Smelt,  Med.  Repos.  vii.  125  ;  J.  Johnson,  84, 
93,  153  ;  Leblond,  81 ;  Rush,  Fev.  of  1780,  iv.  232  ;  Evans,  24;   Ferguson  Recoil.  194; 
Blane,  252;  Davidge,  68;  Boussingault,  An.  de  Chimie,  Ivii. ;  Rochoux,  113;  Bally,  361  ; 
Gilbert,  12  ;   Humboldt,  765 ;   Lefort,  de  la  Saignee,  66  ;  Bayley's  Letters ;   Rep.  on 
Fever  of  N.  0.  in  1819,  p.  50;  Waring,  23;  Chabert,  pp.  ix.  and  26;  McCabe,  Ed.  J.  xv. ; 
Boyle,  44,  75;  Tendleton,  Topogr.  of  Middle  Georgia,  Charleston  J.  vii.  450;   Smith, 
Rep.  to  Assembly,   on  Fever  of  1847  in  N.  Y.   30,  Cyclop,   iii.  64  ;  B.  Perkins,  of 
Boston,  Mem.  of  the  Roy.  Med.   Soc.  of  Paris,  i.   207;   Monfalcon,   79;  Rand,   Med. 
Repos.  ii.  466-8;  Fenner,  Rep.  ii.  442;  Bryson,  Stat.  Rep.  of  II.  of  the  Navy  (Brit.), 
11  ;  Second  Rep.  on  Quar.  14,  15;   Thouvenelle,  Climat  de  1'Italie,  i.  223;  Vincent, 
Dis.  sur  la  F.  J.  10;  Mabit,  Mai.  de  St.  Dom.  5,  6.;   Diet,  de  Med.  Pratique,  vii.  74; 
Volney,  Climat.  des  E.  U.  316. 

2  Malaria :  an  Essay,  93. 

3  Edinb.  R,  xxxvi.  542  ;  Boudin,  Geographic  Med.  70. 

4  Med.  Ch.  Tr.  iii.  ;  Ibid.  Dissertation,  i.  236. 


218  PNEUMONIA    AND 

this,  we  must  allow,  also,  that  the  effect  can  only  be  due  to  the  air 
thus  propelled  being  the  vehicle  of  some  deleterious  agent,  which 
it  receives  from  the  infected  surface,  and  not  to  the  cold  or  heat,  or 
the  vicissitudes  of  temperature,  or  humidity,  which  such  winds 
may  occasion ;  for  these,  as  we  have  seen,  do  not  alone  produce 
fevers,  which  often  arise  under  circumstances  rendering  such  an 
explanation  totally  inadmissible.  They  appear  under  the  influence 
of  the  most  opposite  currents  of  air.  In  some  cases,  a  north,  at 
other  times  a  south,  or  a  west,  or  an  east  wind,  produces  the  effect 
— the  result  depending  solely  on  the  exposure  of  the  suffering  local 
ity,  relative  to  the  position  of  the  source  of  malarial  elimination, 
and  not  on  any  injurious  quality  appertaining  to  the  wind  itself, 
and  existing  independently  of  the  extraneous  poisonous  materials 
the  latter  serves  to  convey  ;  for,  as  long  ago  remarked  by  Schner- 
rer,1  wind  of  itself,  whatsoever  may  be  its  ther  mo  metrical  or  hygro- 
metrical  qualities,  must  be  exonerated  from  the  charge  of  producing 
the  peculiar  morbid  effects  in  question.  Sometimes  the  wind  is  a 
humid,  sometimes  a  dry  one ;  and  surely,  heat  and  cold,  humidity 
and  dryness,  cannot  all  be  fruitful  sources  of  a  disease  which  is 
always  fundamentally  the  same;  while  the  same  winds,  equally 
warm  or  cold,  moist  or  dry,  but  lacking  the  extraneous  poison 
under  consideration,  have  blown  for  months  without  occasioning 
fever. 

It  has  frequently  been  found  in  marshy  countries — and  examples 
of  the  kind  have  been  noticed  from  early  antiquity  in  Dalmatia, 
Calabria,  and  Sicily — that,  by  changing  the  position  of  towns, 
houses,  and  encampments,  so  as  to  avoid  the  effects  of  winds  which 
blow  over  marshy  or  malarious  localities,  or  by  preventing  access 
to  such  winds,  by  closing  carefully  the  doors  and  windows  of  houses 
exposed  to  them,  fevers  have  been  arrested  or  guarded  against. 

Dr.  Dundas  having  noticed  that  fever  attacks  were  very  common 
among  the  inmates  of  the  British  Hospital,  of  which  he  had  charge, 
at  Bahia  (Brazil),  sat  about  remedying  the  evil.  In  the  first  place, 
he  made  several  alterations  in  the  hospital,  and  had  those  windows 
nailed  up,  which  admitted  directly  the  current  of  wind  suspected  to 
cause  the  mischief.  At  the  same  time,  effectual  measures  were 
taken  to  prevent  convalescents  from  being  exposed  without  cloth 
ing.  The  results  of  these  measures  were  immediate,  and  the  evi- 

1  DCS  Epidemics  et  dcs  Contagions,  92. 


AUTUMNAL    FEVERS.  219 

dence  they  offered  was  complete  and  apparently  free  from  all  fallacy. 
From  that  time  intermittent  fever  almost  completely  disappeared 
from  among  the  convalescents  in  the  Bahia  Hospital.1  Of  course 
Dr.  Dundas,  who  ignores  malaria,  attributes  these  results  to  a  cause 
very  different  from  the  mere  shutting  out  of  a  malarial  atmosphere; 
but  his  fact  is  more  useful  than  his  explanation. 

Yarro,  in  his  Treatise  upon  Agriculture,  relates  that  his  name 
sake  Yarro,  a  Roman  general,  who  was  in  great  danger  of  suffering, 
with  a  large  fleet  and  army,  from  a  malignant  fever  at  Couyra, 
having  discovered  the  course  of  the  miasmata  which  produced  it  to 
be  from  the  south,  he  fastened  up  all  the  southern  windows  and 
doors  of  the  houses  in  which  his  troops  were  quartered,  and  opened 
new  ones  to  the  north,  by  which  means  he  preserved  them  from  the 
fever,  which  prevailed  in  all  the  other  houses  of  the  town  and 
neighbourhood. 

This  practice,  to  which  attention  was  specially  called  by  Thouve- 
nelle,  in  his  clever,  but  eccentric  work  on  the  climate  of  Italy  (iv.  13, 
14),  had  not  escaped  the  notice  of  Dr.  Eush,  who  informs  us  that,  in 
1793,  several  families,  who  shut  up  their  front  and  back  doors  and 
windows,  escaped  the  disease  (iii.  83).  It  is  probable,  indeed,  let  it 
be  remarked  en  passant,  that  the  benefit  accruing  from  seclusion  in 
times  of  severe  epidemics  of  yellow  fever  and  plague  may  be  ex 
plained  in  this  way,  arid  not,  as  is  supposed  by  contagionists,  by 
the  avoidance  of  individuals  affected  with  the  disease,  or  of  objects 
supposed  to  be  contaminated  with  the  poison. 

Let  not  the  distance  to  which  the  cause  of  fever  is  here  said  to 
be  occasionally  wafted  by  the  wind,  deter  the  reader  from  lending 
a  willing  ear  to  this  mode  of  transmission.  Many  facts  are  recorded 
to  show  that,  through  the  same  agency,  other  substances,  diffused  in 
the  same  manner  in  the  atmosphere,  as  well  as  some  evident  to  the 
sight,  and  of  much  heavier  nature  than  the  poison  in  question,  have 
been  conveyed  to  a  considerable  distance.  We  are  told,  on  reliable 
authority,  that  on  the  7th  of  May,  1842,  soon  after  the  outbreak  of 
the  great  fire  at  Hamburg,  an  unusual  and  strong  empyreumatic 
odour  was  experienced  at  Potsdam,  at  a  distance  of  more  than  sixty 
leagues,  and  evidently  proceeding  from  the  direction  of  the  burning 
city.  The  ashes  of  Yesuvius  are  sometimes  wafted  as  far  as  Yenice 
or  even  Greece,  the  distance  of  which  from  the  volcano  is  not  less 

1  Sketches  of  Brazil,  233. 


220  PNEUMONIA    AND 

than  500  and  700  kilometres  (375  and  525  miles).  Instances  are 
mentioned  of  volcanic  ashes  having  been  conveyed  much  farther. 
We  learn  that  vessels  at  sea  have,  while  sailing  at  the  distance  of 
700  to  1,000  kilometres  (675  and  750  miles),  west  of  the  African 
coast,  been  covered  with  the  red  sand  of  that  region.1  In  1812,  the 
ashes  of  the  volcano  of  St.  Vincent  were  conveyed  by  the  wind  as 
far  as  Barbadoes.  On  the  same  occasion  those  ashes  fell  to  the 
depth  of  several  inches  on  the  deck  of  a  vessel  at  the  distance  of 
181  leagues  East  of  St.  Vincent.  In  1815,  the  ashes  of  the  Tam- 
boro,  in  the  Island  of  Sumbawa,  were  conveyed  as  far  as  Java, 
(108  leagues),  in  such  large  quantities  as  to  obscure  completely  the 
atmosphere.2  The  odour  of  burnt  turf,  which  characterizes  the  ex 
halations  of  the  Westphalian  marshes,  has,  we  are  told,  been  sensibly 
felt  as  far  as  Brussels,  Liege,  and  even  Paris.3 

The  effects  of  drying,  overflowing  and  reclaiming  marshy  and  sickly 
localities,  and  vice  versa,  prove  the  existence  and  agency  of  malaria. — 
It  may  not  be  improper  to  bear  in  mind  that  the  banks  of  water 
courses,  of  marshy  grounds,  of  ponds  and  lakes,  as  well  as  humid 
alluvial  surfaces,  become,  during  the  drying  process,  the  seat  of  febrile 
diseases  of  the  periodic  kind ;  while  other  localities  in  the  neighbour 
hood,  but  where  such  a  desiccation  is  not  going  on — the  centre  of 
lakes,  or  river  streams,  the  open  sea,  beyond  the  influence  of  land 
air — remain  healthy.  Let  those  sickly  surfaces  be  covered  with 
water,  either  artificially  or  otherwise ;  cover  masses  of  decom 
posing  materials  with  earth  ;  remove  collections  of  putrid  rubbish, 
decayed  timber,  or  decomposed  grass,  or  other  vegetable  matter, 
and  fever,  which  before  prevailed,  will  disappear,  or  greatly  lessen. 
Dry  up  marshy  surfaces,  improve  and  reclaim  the  land  by  artificial 
means,  and  the  same  beneficial  results  will  be  obtained.  On  the 
other  hand,  let  a  surface  of  country  heretofore  healthy — whatever 
be  its  dimensions — be  converted  into  a  marsh,  morass,  or  anything 
of  analogous  kind ;  as  is  yearly  seen  in  various  parts  of  Africa, 
Asia,  and  America ;  let  a  river  bank  be  temporarily  overflowed, 
and  then  partially  dried;  let  a  portion  of  low  land  daily  covered 
by  water  at  high  tide,  be  imperfectly  banked,  in  such  a  way  that 
the  admission  of  the  water  is  only  partially  prevented,  while  its 

1  Bocqucrol,  Sur  les  climats,  250.  2  Couclin,  Geogr.  M&l.  70. 

3  Diet.  Pratique,  art.  Emanation,  vii.  74. 


AUTUMNAL    FEVERS.  221 

complete  egress  is  impeded ;  cut  down  a  forest,  and  thereby  expose 
a  virgin  soil,  rich  in  organic  matter,  or  a  heretofore  harmless,  humid 
surface,  to  the  sun's  rajs ;  upturn  the  earth,  make  deep  excavations, 
dig  canals,  cut  down  bluffs,  partially  remove  the  water  from,  and 
thereby  lay  bare  the  bottom  of,  ponds ;  let  the  alluvion  of  a  river 
encroach  on  the  water  and  give  rise  to  an  extension  of  new-made 
and  imperfectly  dried  ground,  and  fevers,  other  circumstances  aid 
ing,  will  certainly  occur  or  become  more  rife.  All  this  is  placed 
beyond  the  reach  of  doubt.  It  is,  of  course,  impossible,  in  the  space 
to  which  I  am  necessarily  limited,  to  illustrate  these  statements  by 
more  than  a  brief  notice  of  the  principal  facts  connected  with  the 
subject,  which  present  themselves  to  my  memory. 

The  first  effects  of  clearing  land,  &c.  injurious. — Dr.  Rush  remarks, 
in  reference  to  the  epidemics  of  Pennsylvania,  that  intermittents 
and  mild  remittents  were  converted,  from  clearing  the  country, 
into  bilious  and  malignant  remittents,  and  destructive  epidemics ; 
and  that  it  was  not  until  after  years  of  cultivation  that  general 
salubrity  followed.  A  like  change  has  been  found  to  occur  in  most 
parts  of  New  England  as  Avell  as  in  our  Western  and  Southern 
States.1  As  the  tide  of  emigration  advances  westward,  remarks 
an  intelligent  writer,  these  (lake  fevers),  the  prevailing  fevers 
of  Canada,  retire  before  it.  Kingston,  situated  at  the  eastern  ex 
tremity  of  Lake  Ontario,  is,  in  1810,  very  much  healthier  than  it 
was  in  1830 ;  and  Danville,  two  hundred  miles,  and  Amherstburg, 
four  hundred  and  thirty  miles  farther  west,  where,  now,  there  are 
several  cases  of  ague  in  every  house  in  the  course  of  the  year,  will, 
probably,  in  either  ten  or  twenty  years,  be  as  healthy  as  Kingston 
is  now.  Besides  there  being  less  fever  at  Kingston  than  at  the 
other  two  places  mentioned,  its  type  is  intermittent,  while  at  Dan 
ville  and  Amherstburg  it  is  often  remittent.2 

Again,  we  find  this  occurring  in  middle  Georgia,  particularly  in 
that  portion  of  it  lying  west  of  the  Oconee.3  Here  the  country 
boasted,  at  the  origin  of  the  settlement,  of  a  salubrious  climate. 
Ten  years  after,  when  the  forest  trees  had  been  levelled  to  the 

1  Evei'3'where,  the  first  clearing  has  been  attended  with  an  increase  in  the  number 
of  cases,  arid  in  the  malignancy  of  fever;   and,  in  all,  healthiness  has  followed  after 
some  years  of  settlement. 

2  Stratton,  Brief  Notes  on  the  Lake  Fever  of  Canada,  Edinb,  J.  55,  348. 

3  Tendleton,  Charleston  Med.  J.  vii.  451. 


222  PNEUMONIA    AND 

ground,  the  inhabitants  began  to  suffer  much  from  autumnal  fevers, 
and  continued  to  do  so  for  the  next  twenty  years.  "Since  it  has 
become  comparatively  an  old  country,  and  few  new  grounds  are 
brought  into  cultivation,  it  is  quite  healthy,  the  fevers  being  con 
fined  to  the  more  marshy  districts."  See,  as  an  example,  what  has 
been  observed  in  the  single  town  of  Milledgeville.  Dr.  Fort,  in  a 
communication  on  bilious  remittent  fever,  published  in  the  Southern 
Medical  and  Surgical  Journal*  informs  us  that  this  fever  appeared 
there  as  suddenly  as  the  face  of  Nature  had  been  changed  by  the 
hand  of  man,  and  that  for  eighteen  years,  during  the  summer  and 
fall,  it  was  a  formidable  epidemic.  "  Forty  years  have  elapsed  since 
the  settlement  of  that  towrn,  and  the  face  of  the  surrounding  country, 
in  that  time,  has  been  completely  changed.  The  rich  soil  has  been 
washed  away  from  the  hills,  and  its  deeply  sanded  bottoms  have 
become  dry.  The  sources  of  malaria  have  been  dried  up,  and  the 
mortality,  which,  in  Milledgeville,  at  one  time,  from  bilious  fever, 
might  have  been  five  per  cent,  per  annum,  has  diminished  until  now 
the  deaths  from  this  cause  do  not  amount,  annually,  to  more  than 
one  in  two  thousand."2 

The  late  Dr.  Williamson,  of  North  Carolina,  relates  the  following : 
"A  gentleman  in  Craven  County,  lived  on  his  farm  above  forty 
years  Avithout  suffering  by  intermittent  fevers,  though  his  family 
consisted  of  fifty  or  sixty  persons.  There  were  about  100  acres  of 
clear  ground  in  front  of  his  house  that  had  been  cultivated  many 
years ;  but  there  was  a  thick  wood  behind  the  house.  In  the  be 
ginning  of  the  year  1785,  he  caused  all  the  timber  and  shrubs  that 
were  behind  his  house,  within  four  or  five  hundred  yards,  to  be  cut 
down.  His  object  was  pasture  and  a  free  circulation  of  air.  One- 
third  of  his  family,  on  the  next  summer,  was  taken  down  by  inter 
mittent  fevers.  Such  complaints  were  not  more  prevalent  than 
usual  during  that  summer,  in  other  parts  of  the  flat  country. 
Those  fevers  were  certainly  caused  by  exposing  to  the  sun  a  large 
surface  of  fresh  land,  covered  with  putrescent  vegetables."3 

Dr.  Heustis,  in  his  excellent  work  on  the  fevers  of  Alabama, 
alludes  to  a  similar  fact  in  the  following  remarks.  "For  the  first 
three  years  after  my  arrival  in  this  State,  in  1821,  1822,  and  1823, 
the  country  was  dreadfully  sickly,  and  the  mortality  great  and  ap- 

1  Nov.  1848,  iv.  No.  11. 

2  The  same  statement  is  made  by  Dr.  Fort,  in  Ids  Medical  Practice,  07. 

3  Med.  and  Pldlos.  Register,  iii.  344.     Hist,  of  North  Carolina,  ii.  103. 


AUTUMNAL    FEVERS.  223 

palling,  more  especially  near  the  rivers.  The  whole  country  was 
then  new,  and  the  warmth  and  humidity  of  the  season  caused  a  great 
and  rapid  decomposition  in  the  recently  exposed  and  turned  up 
vegetable  matters.  Many  flourishing  towns  upon  the  rivers,  which 
had  risen  up,  as  it  were,  by  the  hand  of  enchantment,  received  a 
sudden  check,  and  became  suddenly,  almost  totally,  abandoned,  from 
death  and  desertion.  Strangers  from,  every  part  of  the  United 
States,  invited  by  the  fertility  of  the  soil,  and  the  beauty  of  the 
country,  and  the  serenity  of  the  climate,  brought  together  by  for 
tuitous  associations,  with  foreign  and  unseasoned  constitutions,  were 
suddenly  swept  off  by  thousands.  In  many  families  there  were  not 
well  persons  sufficient  to  attend  upon  the  sick  and  dying.  Never 
have  I  known  a  time  of  such  general  calamity." 

Similar  results  will  be  found  recorded  in  the  medical  histories  of 
Pennsylvania,  New  York,  and  all  our  other  States,  as  well  as  in 
those  of  England,  France,  Switzerland,  and  other  sections  of  Europe, 
South  America,  and  the  West  Indies.1  In  a  word,  everywhere  we 
find  a  confirmation  of  the  remark  long  made  by  our  sagacious 
Franklin,  "that  all  new  countries  are  healthy  for  a  certain  period 
after  their  first  development.  That  they  become  inhospitable  to 
man,  in  a  partial  state  of  cultivation,  and  again  healthful  when  the 
whole  soil  shall  be  necessarily  cultivated  to  supply  the  wants  of  a 
population." 

Partial  draining  injurious. — Examples  of  the  injurious  effects  of 
partial  draining  and  desiccation  of  wet  localities,  by  artificial  or 
natural  means,  and  conversely  of  the  beneficial  results  attending 
complete  draining  of  marshy  and  insalubrious  surfaces,  or  their 
complete  submersion,  are  numerous  and  conclusive.  They  establish, 
beyond  controversy,  the  fact  that  the  insalubrity  of  marshy  localities 
increases  in  compound  ratio  to  the  degree  of  dryness  they  have 
attained.  They  show  that  the  greatest  insalubrity  and  mortality 
in  such  localities  always  coincide  with  the  period  of  the  greatest 
desiccation,  short  of  complete  dryness;  that  this  effect  occurs  earlier 

1  Volncy,  Climat  des  Etats  Unis,  309;  Forry,  Climate  of  the  U.  S.  313  ;  Drake,  249, 
381,  8,  39(3,  404,  710,  717  ;  U.  Parsons,  Dissert.  200 ;  J.  M.  Smith  on  Epids.  73  ;  Evans, 
15-23  ;  Williams,  ii.  422;  Macculloch,  126,  138,  172  ;  Monfalcon,  180,  181 ;  Cyclopedia, 
iii.  61-2-4-82:  Ludlow,  N.  Y.  Mcd.  and  Phys.  J.  ii.  83;  Leblond,  23;  Lefoulon,  23; 
Julia,  129;  Boussingault,  An.  de  Chimio,  Ivii.  151  ;  Copland,  ii.  758;  Fenner's  Rep. 
ii.  932 ;  Transaction  of  Pemis.  State  Mod.  Soc.  ii.  42-65. 


224:  PNEUMONIA    AND 

in  hot  than  in  cold  latitudes,  where  the  drying  process  is  slo\ver; 
earlier,  when  the  season  is  precocious,  and  the  reverse  when  it  is 
tardy.  In  illustration  of  the  injurious  effect  of  imperfect  drainage, 
by  which  a  surface  covered  with  water,  and  which  before  was  com 
paratively  innocuous,  is  converted  into  a  pestiferous  spot,  the  oft- 
mentioned  case  of  the  monastery  of  the  Chartreuse,  near  Bordeaux, 
in  France,  may  be  cited.  "  A  succession  of  bad  fevers,  before  un 
known,  commenced  immediately  upon  the  removal  of  the  water 
and  the  partial  dryness  of  the  land,  showing  themselves  first  in  that 
part  of  the  town  which  lay  nearest  to  the  land  reformed,  and  lasting 
through  several  years."1  In  1793  (4th  Dec.),  the  revolutionary 
government  of  France,  with  that  questionable  sagacity  which  charac 
terized  most  of  its  measures,  ordered  the  drying  up  of  every  pond 
which  was  susceptible  of  the  change — the  reason  assigned  being 
the  necessity  of  correcting  the  vitiated  air  supposed  to  be  produced 
by  the  water  therein  contained.  Nineteen  months  after,  on  the  1st 
of  July,  1795,  this  law  was  repealed;  because,  in  many  localities,  the 
drying  process  having  converted  ponds  into  marshes,  which  were 
partially  desiccated  after  the  rainy  season,  rendered  the  air  much 
more  insalubrious  than  it  had  ever  been  before.  The  report  made 
on  the  subject  to  government  by  Creuse  Latouche,  judiciously  recom 
mended  the  reconversion  of  the  marshes  into  ponds.2  A  similar 
accession  of  fever  from  partial  and  imperfect  drainage  occurred  at 
Orville  la  Riviere,  in  France  (Department  of  the  lower  Seine). 

Injurious  effects  of  the  overflow  of  land. — The  extensive  prevalence 
of  fever  during  hot  weather,  after  the  overflow  of  river,  lake,  or 
pond  banks,  and  especially  at  the  receding  of  the  water,  is  well 
known  to  all  medical  readers,  and  has  been  noticed  everywhere, 
and  at  all  times.3 

1  Macculloch,  114. 

2  Villcrmc,  Annales  d'llygiene,  xi.  302  ;  Parent  du  Chatclet,  ib.  xi.  808. 

3  Drake,  130,  280,  372,  301  ;  Bancroft,  294  ;  Cycl.  of  Pract.  Mod.  iii.  01 :  Evans, 
25;  Macculloch,  50-70-92;  Williams,  ii.  431  ;   Mem.  de  1'Ac.  de  Mod.  xiii.  044;   xiv. 
1 17,  119  ;  Humboldt,  702  ;  Schiliz/i,  cited  by  Melier,  Mem.  de  1'Ac.  de  Med.  xiii.  044  ; 
Am.  Quart,  llev.  iv.  294  ;  Copland,  ii.  758;  Garrison  Tr.  Am.  Med.  Association,  ii.  191  ; 
Leblond,    183;    Nepple,    135;    Jacquot,    11-22;    Thevenot,    232;    Second    Kept,   of 
Lend.  Commissioners,  1848,  p.  40  ;   U.  Parsons,  205;  Ludlow,  X.  Y.  J.  ii.  80-7  ;  Perier, 
Hyg.  des  Pays.   Chaud.   ii.   174;    Fenner's   llept.   i.   357,  ii.   448;   Barton  Kept.   34; 
Warden,  Nat.  Hist,  of  Kinderhook,  Med.  Ilepos.  ix.  019;   White,  Med.  Ptepos.  ix.  45,  x. 
30  ;  Transactions  of  the  Med.  Soc.  of  the  State  of  Pennsylv.  ii.  71-133  :  Buel  Webster's 


AUTUMNAL   FEVEKS.  225 

At  Massouah  (Egypt),  fever  occurs  every  time  the  sea  overflows.1 
Those  of  our  readers  who  have  examined  the  writings  of  Lancisi, 
may  recollect  the  epidemic  of  Balnesregium,  a  small  town  of  Tus 
cany,  an  interesting  account  of  which  was  sent  to  Lancisi  by  the 
Bishop  of  the  place.  The  disease,  on  that  occasion,  was  evidently  due 
to  the  fall  or  caving  in  of  a  hill-side  damming  up  a  river  stream,  and 
thereby  occasioning  the  inundation  of  the  country  around,  and  the 
exposure  of  the  subjacent  soil  to  the  action  of  the  sun's  rays.2  The 
epidemics  of  Pesaro,  in  1708,  and  of  Toronte  and  Trasilone,3  cities 
of  the  Compagna,  in  1709,  also  referred  to  by  the  same  writer,  were 
equally  satisfactorily  traced  to  a  kindred  cause.  The  inundations 
occasioned  by  the  overflowing  of  the  Tiber,  and  the  disease  result 
ing  therefrom,  are  referred  to  by  Livy,  Dionysius  of  Halicarnassus, 
Dio  Cassius,  Strabo,  &c.  Like  effects  were  observed  and  noted  in 
the  twelfth  and  thirteenth  centuries,  under  the  pontifical  reign  of 
Innocent  III.,  and,  in  the  fourteenth,  under  that  of  Clement  V.,  and 
are  particularly  described  by  Lancisi,  who  accurately  pointed  out 
some  of  the  causes  of  the  disease  to  which  they  gave  rise.  Lancisi 
informs  us  that  the  river  overflowed  its  bank  in  1695.  The  water 
spread  over  a  large  expanse  of  country,  filling  the  ditches,  the 
sewers,  and  the  canals.  This,  too,  was  followed  in  June,  July,  and 
August,  by  extremely  hot  weather.  Decomposition  of  the  sub 
merged  soil  ensued,  and  this  was  followed  by  a  malignant  periodic 
fever,  which  spread  far  and  wide,  and  occasioned  a  great  mortality.4 
The  epidemic  of  pestilential,  or,  as  we  presume,  malignant  autum 
nal  fever,  which  occurred  along  the  Po  at  the  commencement  of  the 
sixteenth  century,  and  is  described  by  Fracastorius,  was  occasioned 
by  the  overflow  of  that  river,  by  which  a  large  portion  of  the 
country  was  covered  with  water,  and  several  extensive  marshes 
were  formed.5  The  epidemic  of  Ferrara  in  1728,  for  an  account  of 
which  we  are  indebted  to  Lanzoni,  was  evidently  produced  by  the 
decomposition  of  organic  matter  arising  from  the  large  quantity  of 
rain  of  the  preceding  years,  followed  by  intense  heat.6 

collection,  54,  55  ;  James  Johnson,  43,  130,  360;  Smelt,  Med.  Repos.  ix.  125;  Harri 
son,  ib.  x.  0;  Hiklreth,  ib.  xi.  346  ;  Pitt,  ib.  xi.  337,  Piltson,  ib.  v.  137;  Worthington, 
ib.  viii.  372  ;  Lipscombe,  Trans.  Am.  Med.  Assoc.  vi.  322. 

1  Auber  Roche,  An.  d' Hygiene,  xxxiii.  22.          2  De  Noxiis,  &c.  lib.  ii.  210. 

3  Ib.  pp.  245  and  334.     '  4  Ib.  149,  &c. 

5  Opera  Onmia  Philosophica  et  Medica,  1555,  4to.  100. 

6  Opera  Omnia,  iii.  4to.  Lausanne. 

15 


226  PNEUMONIA    AND 

The  city  of  Strasburg,  in  France,  is  not  often  visited  by  mala 
rial  fevers.  In  1824,  the  banks  of  the  Ehine  were  overflowed,  and 
remained  for  some  time  under  water.  Soon  after  the  water  had 
receded,  fever  began  to  prevail,  and  continued  to  do  so  during  three 
consecutive  years;  nor  did  it  cease  before  the  soil  had  become 
perfectly  dry.  The  occurrences  which  followed  the  great  crevasses 
of  1816  and  1849,  in  New  Orleans,  and  the  inundation,  from  the 
Pontchar train  Lake,  of  a  large  portion  of  that  city,  in  1830,  are 
fresh  in  our  memories ;  as  also  those  recorded  in  Italy,  Germany, 
Egypt,  India,  Senegal,  Algeria,  and  very  many  parts  of  our  own 
country.  The  irrigations  at  Oran,  Karguantal,  Sibi-bel- Abbas,  and 
other  districts  of  Algeria,1  where  the  practice  is  extensively  applied 
to  agricultural  purposes,  and  is  carried  to  such  an  extent  as  to  occa 
sion  a  sort  of  daily  inundation ;  those  of  some  of  the  departments 
of  France,  as  well  as  those  resorted  to  in  the  rice  plantations  of  this 
country,  have  been  found  to  give  rise  to  the  same  morbific  effects, 
wherever  and  whenever  the  thermometrical  condition  of  the  atmo 
sphere  is  such  as  to  aid  in  the  extrication  of  malarial  effluvia. 

Mr.  Lee,  one  of  the  inspectors  employed  by  the  London  General 
Board  of  Health,  in  reporting  on  the  irrigation  by  water-meadows 
in  AYiltshire,  thus  states  his  information  in  relation  to  them.  It 
not  only  shows,  as  an  agricultural  fact,  the  enormous  quantity  of 
water  requisite  to  produce  a  high  state  of  fertility  on  the  open  gutter 
and  bed  system  of  irrigation,  but  also  that,  for  about  half  the  whole 
year,  these  meadows  are  under  water.  The  first  "turn"  is  during 
winter,  seven  days  on  and  seven  days  off.  The  second  "  turn"  in 
spring,  four  days  on  and  four  days  off.  The  third  in  summer,  three 
days  on  and  three  days  off';  then  three  days  on  and  six  days  off.  In 
every  "  turn,"  except  the  last,  the  periods  of  irrigation  are  equal  to 
those  during  which  the  water  is  shut  off;  but,  during  the  frost,  the 
water  is  kept  on,  if  possible,  altogether.  These  "turns"  include  night 
and  day.  The  whole  of  these  meadows,  therefore,  during  about  half 
the  year,  form  one  large  evaporating  surface,  as  much  as  would  be 
the  case  if  the  whole  were  constituted  an  immense  lake.  Even 
when  the  water  is  off,  the  ground  is  so  saturated  that  the  evapora 
tion  must  still  be  going  on.  No  fen  or  morass  in  any  low-lying, 
ill-chained  district  of  the  country  would,  I  apprehend,  impart,  area 
lor  area,  an  equal  amount  of  moisture  to  the  atmosphere.  The 

1  Jacquot,  23.     Ficvres  a  Quinquina. 


AUTUMNAL   FEVERS.  227 

consequence  is  such  as  might  be  expected — ague  is  extensively 
prevalent  in  this  valley,  and  is  in  some  spots  so  general  that  scarcely 
any  of  the  inhabitants,  rich  or  poor,  young  or  old,  escape  it. 

The  difference  between  the  people  exposed  to  the  influence  of  such 
a  surface  and  others  living  in  neighbouring  parishes  of  equal  popu 
lation,  but  not  subject  to  malaria,  may  be  seen,  as  Mr.  Lee  remarks, 
in  the  dejected  and  haggard  appearance  of  the  former,  and  in  the 
greater  amount  dispensed  among  them  for  poor-rates.  In  the 
course  of  his  investigation  into  the  sanitary  condition  of  the  parish 
of  Longbridge  Deverill,  near  the  town  of  Warminster,  Mr.  Lee 
found  that  in  one  portion  of  that  parish,  the  large  village  of  Crocker- 
ton,  scarcely  any  of  the  inhabitants  had  escaped  ague;  and,  on 
comparing  the  poor-rates  for  seven  years  back  with  those  of  the 
parishes  of  Corsley  and  ITorningsham,  of  about  equal  size,  and  in 
the  same  union,  it  is  seen  that  the  charges  for  sickness  in  Long- 
bridge  Deverill  are  nearly  double.1 

The  conclusions  as  to  the  insalubrity  of  common  irrigation,  and 
its  unfitness  for  the  proximity  of  towns,  are  fully  corroborated  by 
the  fact  that,  in  the  Lombardo-Yenitian  provinces,  where  there  is 
some  of  the  oldest,  most  extensive,  and  skilfully  conducted  irriga 
tion  in  Europe,  the  government  has  long  found  it  necessary  to  in 
terfere  for  the  protection  of  the  health  of  towns.  By  law,  as  stated 
in  some  information  on  the  subject  received  by  the  English  General 
Board  of  Health  from  the  authorities  of  Milan,  "  permanent"  irriga 
tions  are  prohibited  within  five  miles'  distance  of  towns.  These 
permanent  irrigations  are  there  mostly  applied  to  the  cultivation  of 
rice.  Cases  are  reported,  from  the  irrigated  districts,  of  the  appear 
ance  and  disappearance  of  fevers  coincident  with  the  operations  of 
flooding  and  drying  particular  tracts  of  land.  It  appears,  indeed, 
from  extensive  experience,  that,  wheresoever  water  is  laid  on  the 
land  in  greater  quantities  than  it  can  immediately  or  very  soon 
absorb,  or  wheresoever  there  is  alternate  wetting  (in  such  excess) 
and  drying,  malaria  is  apt  to  arise.2 

In  the  Department  of  Marne  and  Loire,  in  France,  the  basin  of 
the  Anthion  is  32  kilometres  in  length,  and  6  in  its  greatest  breadth, 
opposite  to  Corne,  and  contains  1,560  hectares,  or  3,000  acres  of 
submersible  land  between  the  bridge  of  Bourgiernon  and  that  of 


o  o  o 


1  Minutes  of  Information,   &c.   on  Sewer-water  and  Town-manure,   &c.  London, 
1852,  pp.  7,  8. 

2  Ibid.  9. 


228  PNEUMONIA    AND 

Forge,  and  1,016  hectares,  or  2,032  acres,  equally  submersible  land, 
in  another  direction.  It  constitutes  an  immense  focus  of  decompo 
sition,  from  which  are  evolved  effluvia,  and  often  paludal  miasmata. 
In  the  more  depressed  portions  of  this  surface,  the  inundation  is 
as  much  as  ten  feet  deep.  It  is  difficult,  however,  to  obtain  a  com 
plete  desiccation  of  it.  In  1843,  the  whole  of  this  basin  was 
flooded,  and  all  the  ditches  completely  rilled.  The  Anthion,  that 
year,  remained  higher  than  ordinarily.  The  water  continued  to 
cover  the  greater  portion  of  the  soil,  and  it  became  impossible  to  mow 
the  grass  in  a  dry  state.  This  circumstance  of  an  immense  inunda 
tion  ought,  it  would  seem,  to  have  proved  advantageous ;  for  the 
whole  basin  was,  by  the  overflow,  converted  into  an  immense  lake, 
by  which  an  obstacle  was  put  to  the  formation  of  a  marsh.  But  no 
sooner  had  the  water  somewhat  subsided,  and,  by  so  doing,  allowed 
the  exposure  during  the  hot  weather  of  July  and  August,  of  the 
banks  of  the  ditches,  and  of  a  few  hillocks,  than  the  effluvia,  then 
extricated  from  the  mass  of  decomposing  vegetable  and  animal  sub 
stances  therein  contained,  were  wafted  by  the  S.  S.  W.  wind  to  the 
town,  and  infected  the  inhabitants,  among  whom  it  occasioned  the 
development  of  an  extensive  epidemic  of  intermittent  fever.1 

The  following  statement  is  taken  from  a  clever  communication 
contained  in  an  English  periodical: — • 

"  The  summer  in  this  country  (Russia),  is  farther  remarkable, 
inasmuch  as,  from  the  end  of  May  to  the  beginning  of  September, 
no  rain  falls,  and  thunderstorms  are  extremely  rare.  The  pheno 
menon  is  doubtless  owing  to  the  flatness  of  the  country.  For  five 
hundred  miles  and  more,  around  Perm  and  Kassan,  there  is  not  a 
hill  of  any  consequence,  and  the  whole  tract  from  Kiew  to  Ural,  for 
a  breadth  of  five  hundred  miles,  may  be  called  a  plain,  only  here 
and  there  interrupted  by  ranges  of  gentle  hills.  The  extraordinary 
fertility,  especially  of  the  government  of  Kassan,  is  occasioned  by 
the  inundation  of  the  Wolga,  which  overflows  annually  at  particu- 

1  Gaultier  de  Claubry,  Mem.  de  1'Acad.  de  MeU  xiv.  119,  120;  sec  also  117,  for 
another  case  of  the  same  import. 

The  Canton  of  Amizy-le-Chateau  is  situate  in  a  valley,  on  the  south  side  of  the 
city  of  Laon.  In  the  centre  runs  the  small,  sinuous,  and  shallow  river  of  Elete, 
which  is  supplied  with  water  from  a  number  of  creeks.  In  the  neighbourhood,  there 
lire  a  number  of  ponds,  the  whole  subject  to  overflows,  which,  combined  with  the 
peculiar  nature  of  the  soil,  have  given  rise  to  extensive  marshes,  well  known  under 
the  name  of  the  southern  marshes  of  the  Laonnais.  The  canton  is  very  subject  to 
fevers  (Bulletin,  i.  154). 


AUTUMNAL    FEVEKS.  229 

lar  seasons,  as  regularly  as  the  Nile  in  Egypt,  and  converts  the 
whole  country,  to  the  distance  of  ten  miles  or  more  from  its  bed, 
for  five  or  six  weeks,  into  an  immense  sea,  These  inundations  of 
the  Wolga,  and  the  other  large  rivers,  the  Witjalka,  the  Kama,  the 
Kinel,  the  Irgis,  &c.  which  discharge  themselves  into  the  Wolga, 
render  the  countries  through  which  they  flow  at  once  lively  and 
fertile.  At  such  seasons  you  may  sail,  either  for  pleasure  or  upon 
business,  in  large  two-masted  vessels,  carrying  from  six  to  ten  guns, 
over  pastures  and  cornfields,  to  the  neighbouring  towns,  which, 
on  this  account,  are  all  situated  upon  heights;  and,  when  the  waters 
have  withdrawn  into  their  accustomed  channels,  the  ground  for 
saken  by  them  is  covered  often  a  yard  deep  with  a  fertilizing  mud, 
in  which,  during  the  hot  season,  all  vegetables  grow  rapidty  and 
vigorously  as  in  a  hothouse.  At  the  same  time,  pools  are  left 
behind  in  the  low  grounds,  where  the  water  stagnates  for  several 
months,  becomes  putrid,  and  generates  putrid  fevers  in  the  months 
of  July  and  August  in  these  otherwise  healthy  countries.  The 
government  of  Ufa,  particularly,  is  visited  about  this  time  by  an 
intermittent  fever,  which  attacks  the  patient  every  seventh  day 
only,  but  is  so  violent  that  it  generally  proves  fatal."1  "Near  the 
walls  of  a  large  city,"  says  a  celebrated  writer,  "stood  a  very  exten 
sive  and  deep  pond  of  water,  which,  for  forty  years,  had  served  as 
a  receptacle  for  all  the  filth  from  the  houses  and  streets.  As  long- 
as  these  putrid  matters  remained  covered  with  water,  they  were 
productive  of  no  mischief;  but,  when  they  had  so  far  accumulated 
as  to  rise  above  the  surface  of  the  water,  a  most  malignant  fever 
spread  through  the  tract  of  country  adjoining  the  city."2 

Dr.  Cadwallader  Golden,  of  New  York,  who  wrote  a  full  century 
ago,  makes  the  following  remarks : — 

"It  is  well  known  that  the  Paltz  Eiver  or  Wallkill,  in  Ulster 
County,  in  this  province,  has  been  long  taken  notice  of,  as  very 
prejudicial  to  the  health  of  those  who  live  on  the  banks  of  it.  The 
waters  of  this  river  are  of  a  dark  colour,  and  come  from  a  large 
space  of  ground  overflowed  with  stagnating  water.  The  inhabitants 
along  this  river,  are  yearly  afflicted  with  intermittent  fevers  during 
the  summer  season,  and  a  constant  fog  or  vapour  is  observed  almost 
all  the  summer  (except  in  the  time  while  the  K.  W.  or  northerly 

1  Notices  of  Russia,  United  Service  Journal,  January,  1833,  p.  49. 

2  Seiific,  De  Nat.  Febr.  Recond.  lib.  i.  cap.  vii.  fol.  34,  35.     CaldwelPs  Trans,  20. 


230  PNEUMONIA    AND 

winds  blow)  to  arise  over  that  river,  and  to  remain  there  at  a  certain 
height  and  distance  every  morning,  till  the  heat  of  the  sun  disperses 
it,  and  frequently,  likewise,  in  the  evening."1 

About  the  same  time  a  distinguished  physician,  of  this  city,  stated 
the  following  fact :  "A  farm,  within  a  few  miles  of  this  city,  was  re 
markably  healthy  for  fifty  years,  whilst  the  tide  overflowed  the  low 
lands,  near  the  dwelling-house  ;  but  after  they  were  banked  in  by 
ditches,  so  ill-contrived  that  they  did  not  often  discharge  the  water 
that  fell  into  them  for  a  considerable  time,  it  became  putrid,  and 
thereby  rendered  the  place  as  remarkably  sickly  as  it  had  been 
before  healthy.  I  was  told  by  a  gentleman  of  veracity  that  he  saw 
the  corpses  of  nine  tenants,  that  had  been  carried  from  it  in  a  few 
years."2 

Between  Winchester  and  Charlottesville,  in  the  valley  of  Virginia, 
is  situate  a  remarkably  large  and  deep  spring,  from  which  extends 
a  low,  marshy  piece  of  ground  about  a  mile  long,  and  perhaps  one 
hundred  yards  wide.  All  around  this  marsh  the  people  have  been 
annually  subject  to  fevers  in  an  unusual  degree.  In  the  very  wet 
year  of  1823,  however,  the  marsh  being  inundated,  they  almost 
entirely  escaped.3  The  readers  of  Pringle  will  remember  the  occur 
rences  in  Brabant  during  the  campaign  of  1748.  "The  country 
bordering  upon  the  lower  part  of  the  Maas  is  not  only  unhealthful 
on  this  account  (the  humidity  of  the  soil  under  the  surface),  but, 
by  reason  of  floods  from  the  small  rivers,  lies  all  the  winter  under 
water,  and  continues  damp  throughout  the  summer.  The  moisture 
and  corruption  of  the  air  were  much  increased  by  the  inundations 
(which  had  been  made  about  the  fortified  towns  since  the  com 
mencement  of  the  war),  and  sensibly  became  more  noxious  upon 
letting  off'  part  of  the  water,  in  the  beginning  of  the  summer."4 

Dr.  Eobert  Hamilton,  of  Lynn  Eegis,  in  a  pamphlet  quoted  by 
Bancroft,  and  referred  to  particularly  in  the  Lond.  Med.  Gaz.,  de 
scribes  a  remittent  fever  produced  in  that  place,  in  1779,  by  a  freshet 
which  occasioned  an  inundation  from  the  sea.  "The  inundations 
from  the  sea  are  generally  followed  by  severer  consequences  in  re 
spect  to  health,  than  those  from  the  fresh  water.  If  they  extend  far, 
they  cover  much  low  ground  under  cultivation,  and  fill  many  ditches, 

1  N.  Y.  Med.  and  Philos.  Register,  i.  323. 

2  Bond,  Tntrod.  Lect.  N.  A.  Med.  and  Surg.  J.  iv.  270. 

3  Cooke  on  Eped.  Fevers,  Med.  Recorder,  vii.  457,  8. 

4  Diseases  of  the  Army,  01. 


AUTUMNAL    FEVERS.  231 

which,  in  many  situations,  cannot  be  drained  by  any  other  means 
than  evaporation  by  the  heat  of  the  sun."  "  The  remittent  fevers 
which  follow  are  of  the  worst  kind; — the  effect  being  due  to  the 
dead  fish  that  remain,  and  the  effluvia  from  the  destruction  of  rep 
tiles,  insects,  &c.,  and  vegetables  which  are  destroyed  by  the  sea 
water."  The  gale  of  1779  was  attended  by  such  an  inundation,  the 
effect  of  which,  developed  by  the  heat  of  five  successive  summers 
and  autumns,  were  seen  in  the  fevers  of  those  years,  which  were 
more  violent,  universally  epidemic,  and  more  fatal  than  Dr.  Ilarnil- 
ton  had  seen  them  in  the  past  forty  years.  These  fevers  have 
ceased  to  show  themselves.  The  country  around,  which  was  one 
of  the  most  unhealthy,  has  become  one  of  the  most  salubrious,  by 
the  complete  draining  of  the  Bedford  level.1 

"Near  Guerande  and  Pont  Chateau,  several  localities  on  the  coast 
of  Britanny  partake  more  or  less  of  the  insalubrity  of  marshy  sur 
faces.  Among  these  may  particularly  be  cited  the  towns  of  Dinan, 
Dol,  Lamballe,  and  their  environs,  in  consequence  of  the  high  tides 
occurring  on  this  part  of  the  coast,  and  resulting  from  the  obstacles 
to  the  free  flow  of  the  sea  from  the  western  coast  of  the  Cotentin. 
The  waters  thrown  back  by  that  coast  are  carried  to,  and  accumu 
late  in,  the  bays  of  St.  Michel,  St.  Malo,  and  St.  Brieux,  where  they 
rise  to  the  height  of  forty  feet,  and  overflow  the  country  far  beyond 
Dinan,  spreading  miasmata  to  the  north  and  south."  In  the  same 
way,  in  the  Bay  of  Isigny,  the  sea  rises  to  a  great  height,  and  occa 
sions  the  overflow  of  the  rivers,  especially  in  the  vicinity  of  Carentan, 
which  is  surrounded  by  stagnant  water  during  several  months  of 
the  year.  "Hence  the  city  and  its  environs  are  seldom  free  from 
fevers  and  other  kindred  diseases."2  "  In  the  province  of  Poitou, 
the  insalubrity  of  most  of  the  towns  and  villages  arises  in  like 
manner  from  the  exhalations  generated  in  the  morasses  and  ponds 
by  which  they  are  surrounded,  owing  to  the  overflow  of  the  rivers. 
Thus  the  Sevre,  in  which  the  sea  penetrates,  overflows  its  stagnant 
waters  during  several  months  of  the  year,  to  the  depth  of  two,  four, 
and  even  six  feet,  and  inundates  the  whole  country  around  Lucon, 
Maillezais,  and  Marans,  as  far  as  two  leagues  below  Niort,  thereby 
forming  a  marsh  of  65,085  arpents  in  extent.  All  this  country  is 
subject  to  intermittent  fevers  and  other  diseases."3 

1  Lend.  Med.  Gaz.  xxviii.  790. 

2  Boncerf,  Mem.  de  la  Soc.  Roy.  de  Med  viii.  282,  3. 

3  Ib.  282. 


232  PNEUMONIA    AND 

Mr.  Ives,  in  the  narrative  of  his  travels  from  India  to  Europe  by 
land,  relates  the  following  interesting  and  apposite  fact : — 

"  After  sailing  up  the  Kiver  Tigris,  from  Bassora,  we  arrived  at 
Bagdad.  In  this  city,  supposed  to  contain  500,000  souls,  a  purple 
fever  then  raged;  but  though  it  was  computed  that  an  eighth  part 
of  the  inhabitants  were  ill,  yet  the  distemper  was  far  from  being 
mortal.  Here  we  were  informed  that  the  Arabs  had  broken  down 
the  banks  of  the  river  near  Bassora,  with  a  design  to  cover  with 
water  the  deserts  in  its  neighbourhood.  This,  it  seems,  is  the  usual 
method  of  revenge  taken  by  the  Arabs,  for  any  injury  done  them 
by  the  Turks  in  Bassora ;  and  it  was  represented  to  us  as  an  act  of 
the  most  shocking  barbarity,  since  a  general  consuming  sickness 
would  undoubtedly  be  the  consequence.  This  was  the  case  fifteen 
years  before,  when  the  Arabs,  by  demolishing  the  banks  of  this 
river,  laid  the  environs  of  Bassora  under  water.  The  stagnating 
and  putrid  water  in  the  adjacent  country,  and  the  great  quantity 
of  dead  and  corrupted  fish  at  that  time  lying  upon  the  shore,  pol 
luted  the  whole  atmosphere,  and  produced  a  putrid  and  mortal 
fever.  Of  this  fever,  between  12,000  and  14,000  of  the  inhabitants 
died ;  at  the  same  time,  not  above  two  or  three  of  the  Europeans 
who  were  settled  there  escaped  with  life."1 

In  the  summer  of  1780,  a  violent  remittent  prevailed  in  that 
city,  so  general  in  its  attacks,  and  so  fatal  in  its  effects,  that  it 
destroyed  25,000  persons,  and  was  called  a  plague.  The  disease 
on  this  as  on  other  occasions  was  manifestly  owing  to  the  cause 
mentioned,  which,  after  moistening  to  saturation  a  great  extent  of 
the  banks  of  the  river,  was  speedily  followed  by  intense  solar  desic 
cation,  during  which  the  fever  appeared.2  Indeed,  the  same  effects 
are  frequently  produced  at  Bassora,  and  to  a  highly  destructive 
degree,  after  the  ordinary  overflowing  of  the  Euphrates.  Of  the 
consequences  arising  from  simple  inundation,  Egypt  affords,  as  we 
have  seen,  a  similar  example;  inasmuch  as  its  season  of  fever  com 
mences  with  the  subsidence  of  the  Nile.  Every  one  must  know, 
that  equally  disastrous  results  have  often  followed  the  overflowing 
of  the  Adige,  the  Po,  the  Scheld,  the  Saave,  the  Theisse,  the  Don, 
the  Tigris,  and  other  streams. 

Hungary  is  as  sickly  a  country  as  any  other  in  Europe,  and  is 

1  Lind,  on  Hot  Climates,  118,  119. 

2  Craigic's  Practice,  i.  172  ;  Trans,  of  a  Society  for  the  Improvement  of  Med.-Chir. 
Knowledge,  ii.  55. 


AUTUMNAL    FEVERS.  233 

scarcely  exceeded  in  that  respect  by  any  on  this  side  of  the  Atlantic, 
or  in  Africa.  Its  fevers,  which  in  the  short  space  of  a  few  years 
destroyed  forty  thousand  Austrian  soldiers,  has,  under  the  name  of 
morbus  Hungarians,  become  familiar  to  all  medical  readers.  Here, 
the  same  causes  which  render  other  localities  injurious  to  health, 
and  prolific  of  febrile  complaints,  subsist  in  an  eminent  degree. 
"  Hungary  abounds  in  rivers,  some  of  great  magnitude — the  Danube 
and  the  Drave,  which,  by  often  overflowing,  leaves  that  low,  flat 
country  overspread  with  lakes  and  ponds  of  stagnating  water,  and 
with  large  unwholesome  marshes."1 

The  fevers  of  Senegal,  described  by  Thevenot,  and  before  him 
by  Schotte,  are  due  to  the  annual  inundation  of  the  river  of  that 
name.  Containing  but  little  water  during  eight  months  of  the  year, 
it  fills  up  rapidly  during  the  wet  season,  and,  soon  rising  to  a  height 
of  more  than  38  or  40  feet  beyond  its  proper  level,  spreads — as  do 
also  its  many  tributary  streams  and  neighbouring  lakes,  which 
before  were  dried  up — its  waters  over  the  whole  country,  which 
now  presents,  like  Egypt,  during  the  inundation  of  the  Nile,  the 
appearance  of  a  vast  expanse  of  water  dotted  over  with  villages. 
On  the  subsidence  of  this,  fever  breaks  out.2 

"  The  garrison  of  Fort  Augusta,  which  stands  very  near  some 
marshes,  to  which  it  is  to  leeward  when  the  land  wind  blows,  w^as 
yet  remarkably  healthy;  but  it  became  at  one  time  extremely 
sickly  upon  the  breaking  in  of  the  sea  in  consequence  of  a  high 
tide,  whereby  the  water,  which  was  retained  in  the  hollows  of  the 
fort,  produced  a  putrid  moisture  in  the  soil,  exhaling  a  vapour  of 
fensive  to  the  smell,  and  with  all  the  noxious  effects  upon  health 
commonly  arising  from  the  effluvia  of  marshes."3 

The  yellow  fever  epidemic  of  La  Guayra,  in  1797 — the  first 
known  to  have  occurred  in  that  place — has  been  referred,  with 
much  plausibility,  to  the  overflowing  of  the  river  of  that  name. 
"  This  torrent,  which  in  general  is  not  ten  inches  deep,  was  swelled, 
after  sixty  hours  of  rain  in  the  mountains,  in  so  extraordinary  a 
manner  that  it  bore  down  trunks  of  trees  and  masses  of  rocks  of 
a  considerable  size.  During  this  augmentation,  the  waters  were 
from  thirty  to  forty  feet  in  breadth,  and  from  eight  to  ten  feet  in 
depth.  Many  houses  were  carried  away  by  the  torrent,  and  the  in- 

1  Lind  on  Seamen,  59  ;  Tringl.  189. 

2  Thevenot,  Maladies  des  Europeens,  &c.  20,  21. 

3  Bliine,  Diseases  of  Seamen,  2d  edit.  229,  note. 


234  PNEUMONIA    AND 

undations  became  more  dangerous  for  the  stores,  in  consequence  of 
the  gate  of  the  town,  which  could  alone  have  given  an  issue  to  the 
waters,  being  accidentally  shut.  It  was  necessary  to  make  a  breach 
in  the  wall  in  the  sea-side ;  more  than  thirty  persons  perished."1 

Bad  effects  of  copious  rains  followed  by  great  and  desiccating  heat. — 
A  wet  season,  or  heavy  temporary  rains,  by  converting  dry  and 
heretofore  healthy  tracts  of  country  into  swamps  or  marshes,  or  by 
merely  thoroughly  softening  a  soil  previously  hardened  by  a  dry 
spell  of  weather,  and  mostly  destitute  of  vegetation,  has,  when  fol 
lowed  by  heat,  given  rise  to  a  considerable  extent  of  disease.2  Hence, 
in  localities  which  are  naturally  dry,  or  which  have  been  rendered 
so  by  long-continued  and  intense  heat,  the  rainy  season  is  that  of 
the  greatest  insalubrity,  and  continues  so  until  the  soil  becomes  com 
pletely  submerged.  Indeed,  the  fresh  rains  often  become  the  signal 
for  the  breaking  out  of  the  disease.  Among  the  many  facts  that 
might  be  cited  in  corroboration  of  the  former  statement,  I  shall  select 
the  following:  In  Corsica,  fevers  break  out  in  August  and  Septem 
ber,  not  only  along  the  marshes,  but  in  the  villages  situate  between 
the  mountains,  on  the  occurrence  of  heavy  showers.3  Speaking  of 
1839,  Mr.  Gouraud  says :  "  I  was  beginning  to  think  that  the  extent 
of  the  annual  endemic  had  been  greatly  exaggerated.  On  the  20th  of 
August,  during  a  very  hot  spell  of  weather,  we  had  a  shower.  The 
latter  produced,  instantaneously,  a  very  offensive  odour,  and  decided 
the  development  of  pernicious  intermittents."4  Similar  effects  of 
the  first  rains  are  noticed  in  the  Morea.  On  their  landing  there,  in 
1828,  the  French  troops  were  exposed  to  intense  heat  by  day  and 
cold  by  night.  These  vicissitudes,  succeeding  to  a  long  period  of 
dry  ness,  invited  the  approach  of  the  annual  epidemic.  Kain  fell  in 
heavy  showers  on  the  18th  and  19th  of  September,  and  the  disease 
broke  out  on  the  20th.5  A  gentleman,  living  on  the  ridge  land 
between  the  Opequon  and  the  Shenandoah  Eivers,  in  Virginia,  in 
formed  Dr.  Cookc,  from  whose  essay  on  Epidemic  Fevers  I  quote: 
"That  he  had,  for  nineteen  years  before  1823,  scarcely  known  what 
sickness  in  his  family  was.  A  neighbour  had  been  in  the  habit, 
for  many  years,  of  watering  his  meadow  by  small  rills,  from  his 
mill-race.  Before  this  wet  year,  the  quantity  he  could  spare  was 

1  Humboldt,  Pers.  Nar.  iii.  202. 

2  Villemic,  An.  d'llyg.  xi.  350;   Leblond,  100,  184. 

3  Gournud,  Ktudes  sur  les  F.  Interm.  Pemicieuses  dans  les  contrdcs  meridionales,  37. 

4  lb.  40.  5  /£t  218. 


AUTUMNAL   FEVERS.  235 

very  small,  and  not  enough  to  make  the  ground  wet,  the  moisture 
being  absorbed  immediately.  This  year,  however,  it  was  quite 
marshy,  and  the  road  through  it  very  bad.  The  consequence  was, 
that  a  great  number  of  persons  died  in  the  houses  just  around  the 
meadows."1 

In  1830,  the  city  of  Macacu,  in  the  Province  of  Eio  Janeiro  (Bra 
zil),  on  the  banks  of  the  river  of  that  name,  suffered  extensively  from 
periodic  fever.  The  district  around  the  city  is  rich  in  virgin  forests 
and  in  coffee,  sugar,  rice,  and  other  plantations.  Thence  the  disease 
extended  far  and  wide,  occupying  a  surface  of  argillaceous  soil,  cut 
up  by  numerous  streams,  torrents,  and  lakes  bordered  with  man 
groves,  and  subject  to  inundation  at  high  tides.  The  epidemic  was 
evidently  due  to  a  great  drought,  which  occurred  in  1829-30,  and 
succeeded  to  heavy  rains,  which  flooded  the  country.2 

It  may  be  mentioned,  in  illustration  of  this,  that  sickly  seasons  are 
generally  those  in  which  a  wet  spring  is  followed  by  a  hot  summer. 
AYe  have  seen  that  in  Africa,  in  the  East  Indies,  in  the  Antilles,  and 
in  South  America,  fevers  make  their  appearance  at  the  commence 
ment  and  a  short  time  after  the  close  of  the  rainy  season;  when, 
consequently,  the  soil  is  not  yet  deluged  with  water,  or  when  it  has 
ceased  to  be  so,  and  offers,  by  its  exposure  in  a  moist  state  to  the 
evaporating  power  of  the  sun,  and  by  the  greater  luxuriance  of 
vegetation  which  ensues,  ample  food  for  the  generation  of  the  febrile 
poison.  This  is  equally  true,  both  as  regards  common  autumnal, 
and  malignant  yellow  fever.  While  they  all  often  commence  and 
rage  soon  after  the  appearance  of  rain,  and  are  sometimes  put  a 
stop  to  by  excessive  and  long-continued  drought,  they  seldom  break 
out  in  an  epidemic  form  during  a  very  dry  spell  of  weather,  unless 
the  latter  has  been  preceded  by  a  wet  spring,  or  a  quick  succession 
of  heavy  showers,  by  which  the  earth  is  thoroughly  saturated. 
Facts  illustrative  of  these  effects  have  been  observed  everywhere, 
both  abroad  and  in  this  country.3  It  is  on  those  observed  by  him- 

1  Med.  Recorder,  vii.  457. 

2  Sigaud,  du  Climat  et  dcs  Mai.  du  Brazil,  170-2. 

3  Town,  7-0;   Warren,  8;   Clialmers,  i.  19-22;   Macartney,  quoted  by  Dickson,  Ed- 
inb.  Journ.  xiii.  47;   Humboldt,  765;  Desportes,  i.  17,  121  ;   Lind,  50;  Bailly,  Fievres 
Interm.  180;   Clark,  Med.  Notes  on  Climate  of  Italy,  80;    Tommasini,  ii.  488,  9;  Da 
vidson,  quoted  by  Rush,   iv.    155;  Halphen   (of  N.   0.),  42,   43;   Pallas,  209,  210  ; 
Report  of  Sickness  of  British  Army,  4-23  ;  Savaresi,  256,  257,  292  ;  Pugnet,  344,  345  ; 
Mosely,  10,  11  ;   Chisholm,  i.  14G,  147;   Belcher,  Ed.  Journ.  xxiii.  248;    Dariste,  33; 
Davidson,  Med.    Repos.   viii.  248.  249  ;    Catel,  7  :   Dazille,  10 ;  Ed.  Journ.  Ixiii.  448 ; 
Dupre,  Am.  Journ.  N.  S.  iii.  205;  E.   II.  Smith,  Webster's  Collection,  75;  Bayley, 


236  PNEUMONIA    AND 

self  and  others  in  the  West  Indies,  though  especially  in  Holland,  Spain, 
and  Portugal,  that  Dr.  Ferguson  built  his  theory  of  the  exclusive 
agency  of  the  drying  process,  that  grew  with  him  into  a  hobby,  which 
he  rode  manfully  and  with  much  ability  to  the  last  day  of  his  life, 
and  which  a  few  of  our  countrymen  would  seem  disposed  to  mount, 
strangely  unmindful  of  many  other  facts  which  strongly  militate 
against  its  exclusive  adoption,  and  show,  as  we  have  seen,  that, 
under  certain  circumstances,  malarial  fevers  not  unfrequently  ap 
pear  under  the  influence  of  the  luetting  process. 

The  establishment  of  mill-dams,  and  the  subsequent  partial  de 
siccation  of  the  soil,  have  the  same  effect.  Dr.  0.  "W.  Holmes,  who, 
besides  writing  amusing  poetry,  composes  excellent  medical  essays, 
adduces,  in  a  work  of  marked  ability,  a  large  body  of  facts,  showing 
the  injurious  effects  of  these  dams,  and  of  ponds.1  Dr.  Rush, 
in  enumerating  the  causes  of  the  increase  of  remittent  bilious 
fever  in  and  about  the  year  1785,  mentions,  prominently,  the  esta 
blishment  of  dams  ;2  and  Yolney  has  expressed  himself  strongly  in 
their  condemnation.3  Harrisburg,  in  this  State,  situate  between 
the  Eiver  Susquehanna  and  a  small  creek,  and  extending  nearly  or 
quite  from  one  to  the  other,  furnishes  an  acceptable  illustration  of 
the  above  fact.  In  the  year  1773,  a  dam  was  built  across  the  creek, 
in  the  rear  of  the  town,  and  thereby  produced  a  very  extensive 
and  shallow  pond.  In  the  fall  of  the  year  succeeding,  a  mortal 
fever  prevailed  in  the  town,  which  was  satisfactorily  traced  to  the 
influence  of  that  pond.  The  people  insisted  on  having  the  dam 
removed.  The  pond  was  completely  drained,  and  the  town  was  as 
healthy  afterwards  as  it  had  been  before  that  time.4  Mifflin  County, 
in  this  State,  is  generally  free  from  sources  of  miasmal  exhalations. 
In  1823,  intermittent  fever  prevailed  extensively;  but  it  was  con 
fined  exclusively  to  the  immediate  vicinity  of  mill-clams.  A  few 
cases,  in  the  more  healthy  districts,  could  be  traced,  in  every  in 
stance,  to  the  same  source,  or  to  a  visit  to  the  river.5 

53,123;  Ralph,  Edinb.  Mcd.-Cliir.  Trans.  55-GO ;  Doughty,  187,188;  Lewis,  N.  0. 
Journ.  for  July,  1848,  p.  38  ;  Pinkard,  ii.  GO  ;  Lebloud,  vii.  100,  100;  Villerme,  An. 
cTIIyg.  xi.  350. 

1  Boylston  Prize  Dissertations  (Interm.  Fever)  47. 

2  Rush,  An  Inquiry  into  the  Causes  of  the  Increase  of  Remittent  ami  Intermittent 
Fevers  in  Pennsylvania.    Philosoph.  Trans,  ii.  200. 

3  Volney,  Climat  ties  E.  U.  ii.  309,  &c. 

4  Cooke  on  Epid.  Fev.  Mod.  Recorder,  vii.  452. 

*  Traus.  of  State  Mod.  Society,  ii.  44;  see  also  p.  47. 


AUTUMNAL   FEVERS.  237 

Dr.  Drake,  in  his  imperishable  volume,  relates  the  following 
strong  fact :  The  village  of  Washington,  in  the  State  of  Ohio,  stands 
on  the  north-east  side  of  Paint  Creek.  About  the  year  1820,  a  mill- 
dam  was  erected  a  short  distance  above  the  town,  which  caused  the 
inundation,  to  the  depth  of  a  few  feet,  of  about  sixty  acres  of  bottom 
land.  As  the  stream  generally  fell  too  low,  by  the  first  of  June,  to 
admit  of  grinding  at  the  mill,  it  was  the  custom  of  the  proprietors 
to  open  the  floodgates,  and  let  the  water  escape,1  after  which  the 
copious  showers  of  that  month  commonly  washed  aAvay  the  recent 
deposits,  and  thus  the  health  of  the  village  did  not  appear  to  suffer. 
In  the  year  1838,  the  owners  did  not  let  off  the  water  until  July, 
and  no  rains  followed  to  wash  away  the  silt.  In  a  short  time  an 
offensive  smell  was  wafted  from  this  foul  and  drying  surface  into 
the  village,  which  was  to  its  leeward,  and,  in  the  month  of  August, 
the  inhabitants  began  to  sicken  with  remittent  and  intermittent 
fevers.  Those  who  lived  on  streets  nearest  to  the  pond,  suffered 
most.  The  people  who  resided  in  the  vicinity,  to  the  west,  or 
windward,  did  not  suffer.  No  epidemic,  so  severe,  had  ever  visited 
the  village  before.  In  the  succeeding  years,  up  to  the  time  of 
Dr.  D.'s  visit,  in  1840,  the  waters  had  been  drained  off  the  first  of 

1  Speaking  of  the  upper  Cuyahoga  Basin,  Dr.  Drake  remarks  that  it  is  annually 
more  or  less  infested  with  autumnal  fever,  although  elevated  eleven  hundred  feet 
above  the  sea,  and  in  the  mean  latitude  of  41°  30'  N. ;  but  the  banks  of  the  ponds 
and  marshes  are  much  infested.  "  Thus,  I  was  told  by  Mr.  Coles,  of  Chardon,  that 
when  a  dam  was  built  across  the  Cuyahoga,  at  Burton,  the  people  were,  in  the  two 
next  years,  generally  attacked  by  autumnal  fever;  and  Dr.  Hamilton,  of  the  same 
town,  informed  me  that,  in  the  neighbourhood  of  Burton,  a  dam  was  demolished  in 
summer  or  autumn,  and  nearly  all  the  labourers  engaged  in  the  work  sickened  with 
fever.  From  Dr.  Bennett,  of  Sharlesville,  I  received  the  following  facts :  The  Cuya 
hoga  flows  near  the  western  side  of  that  village,  from  east  to  south-west.  To  obtain, 
water  for  the  Mahoning  Canal,  a  dam  was  thrown  across  the  river,  which  gave  rise  to 
many  cases  of  fever.  Two  years  afterwards  a  higher  dam  was  erected,  lower  down 
the  river,  which  raised  the  water  to  the  level  of  the  first,  involved  the  ruin  of  an  old 
mill,  produced  stagnant  water  in  the  mouths  of  many  small  streams,  inundated  some 
forest  land,  and  so  intercepted  the  volume  of  water  flowing  in  the  river,  that  when 
it  became  reduced,  in  autumn,  the  whole  was  transmitted  through  the  canal-feeder, 
leaving  but  a  series  of  pools  in  the  partially  dried  up  river  bed  below.  During  the 
first  autumn  after  this  signal  change  in  the  condition  of  the  river,  no  injury  to  health 
was  experienced ;  but  in  the  next,  nearly  all  the  inhabitants,  on  both  sides  of  the 
river,  above  and  below  the  new  dam,  were  attacked  with  autumnal  fever.  The  num 
ber  of  cases  was  estimated  at  one  hundred  and  fifty.  They  who  lived  near  the  river 
had  intermittents ;  those  who  resided  farther  off,  and  on  higher  ground,  suffered  more 
from  remittents."  Pp.  372,  3. 


238  PNEUMONIA    AND 

June,  and  much  of  the  drift-wood  and  filth  cleared  away ;  in  con 
sequence  of  which,  apparently,  the  epidemic  had  not  occurred. 

The  same  writer  relates  the  following  example :  "On  Cedar 
Creek,  a  tributary  of  the  Cumberland  River,  a  mill-dam  had  been 
erected,  about  sixteen  feet  high.  After  twenty-two  }^ears,  the  basin 
having  become  filled  with  silt  and  dross,  the  dam  was  torn  down, 
and  the  perpendicular  face  of  the  deposit  exposed  to  the  action  of 
the  sun  and  air,  in  the  month  of  August.  The  consequence  of  this 
was,  that  nearly  all  the  men  who  performed  this  labour  were  seized 
with  severe  autumnal  fever,  and  one  died.1" 

The  following  fact  is  related  by  another  American  writer,  Dr.  Lud- 
low,  of  New  York.  A  mill-pond  in  the  vicinity  of  Lyons,  Ontario 
County,  which  overflowed  ten  or  fifteen  acres  of  land,  was  drained, 
in  the  summer  of  1822,  for  the  first  time,  the  mill  having  been  built 
about  five  years.  In  consequence,  about  thirty  people  in  the  im 
mediate  vicinity  were  taken  suddenly  ill,  seven  or  eight  of  whom 
died.  Some  of  the  intermittents  Avere  very  malignant.2 

Macculloch  refers  to  equally  strong  facts  as  observed  in  the  iron 
district  of  Glamorganshire,  at  Hirwren,  and  other  parts  of  South- 
end,  near  Lewisham,  in  Hertfordshire,  and  elsewhere  in  England.3 

Injurious  effects  of  upturning  the  earth  in  hot  iceather. — It  has 
already  been  stated  that  the  digging  of  canals,  the  opening  of 
ditches,  the  cutting  down  of  bluffs,  the  levelling  of  lots,  the  filling 
up  or  digging  down  of  streets,  the  opening  of  roads,  the  establish 
ment  of  brickyards,  &c.  have  proved  highly  injurious,  not  only  in 
this  country,  but  in  parallel  or  hotter  latitudes,  as  also  during  the 
hot  seasons  of  cold  regions.  The  results  of  operations  of  the  kind 
in  the  East  and  West  Indies  are  on  record,  and,  like  those  in  Alge 
ria,  an  account  of  which  has  recently  appeared,  are  of  a  nature  not, 
to  be  easily  forgotten.  Near  Tlerncen,  in  Algeria,  nearly  all  the 
soldiers  employed  in  digging  a  well  were  attacked  with  fever,  while 
all  the  others  in  the  vicinity  escaped.4  The  opening  of  roads,  and 
the  upturning  of  the  earth  for  various  purposes,  are  recognized,  by 
the  entire  body  of  physicians  attached  to  the  French  armv  in  that 

1  Topogr.  &c.  of  the  Miss.  Valley,  717. 

2  A  Stat.  and  Med.  Account  of  the  Genesee  Country,  N.  Y.     New  York  Med.  and 
rhys.  J.  ii.  89. 

3  Op.  cit.  101-103.  *  Jacquot,  Fievres  a  Quinquina,  29. 


AUTUMNAL   FEVERS.  239 

country,  as  having  given  rise  to  the  extensive  development  of  fever.1 
The  writings  of  Dr.  Drake,2  so  often  cited,  those  of  Evans,3  Blane,4 
Cassan,5  Macculloch,6  Usher  Parsons,7  Caldwell,8  Bayley,9  Tho 
mas,10  Anderbach,11  Davy,12  Graultier  de  Claubry,13  and  many  others, 
abound  in  similar  cases.  Dr.  Merrill,  in  an  essay  on  the  yellow 
fever  of  Natchez,  has  taken  great  pains  to  show,  and  with  every 
appearance  of  success,  that  the  epidemic  of  1823  arose  from  the 
levelling  of  the  streets,  and  the  consequent  exposure  of  the  fresh 
soil  to  the  action  of  the  hot  sun.14 

The  same  able  physician,  in  an  excellent  and  interesting  anniver 
sary  address  read  before  the  Medical  Society  of  Memphis,  Tennessee^ 
on  "  the  health  and  mortality"  of  that  growing  city,  has  traced  the 
great  sickness  and  loss  of  life  that  recently  occurred  there,  princi 
pally  to  the  work  of  grading  and  digging,  which  has  been  exten 
sively  carried  on  for  several  years  past,  and  which  produce  an 
obstruction  to  free  drainage.  "  In  this,"  says  Dr.  Merrill,  "  I  am 
sustained  by  the  opinion  of  Dr.  Grant,  in  his  able  address  before 
this  Society  at  our  last  anniversary,  by  many  of  the  members  of 
the  Society,  by  the  Board  of  Health,  and  by  many  persons  of  learn 
ing  and  experience  who  are  not  members  of  the  medical  profession."15 

The  injurious  effects  of  these  works  is  farther  illustrated  by 
occurrences  in  Charleston,  in  1842  and  1852:  "In  1842,  white 
labourers,  strongly  predisposed  to  yellow  fever,  were  employed  in 
opening  drains  and  other  works,  and  transferring  the  earth  to  dif 
ferent  portions  of  the  city;  and  where  the  drains  were  opened  and 
the  earth  was  deposited,  there  yellow  fever  occurred,  and  the  unfor 
tunate  beings  who  performed  that  work  were  the  greatest  victims. 
In  1852,  the  same  thing  occurred."16  Dr.  Simons  remarks,  in  a  note, 
that,  in  reference  to  the  last-mentioned  year,  at  the  new  custom- 

1  Ibid.  13-29.  2  Op.  cit.  182,  229,  235-239,  372. 

3  Op.  cit.  75,  266.  4  Dissertations,  i.  332. 

5  Mem.  de  la  Soc.  Med.  d'Emulation,  v.  142. 

6  Op.  cit.  83,  &c.  7  Essay  on  Malaria,  in  vol.  of  Essays,  206. 
8  Essay  on  Miasm,  Boston  J.  ii.  504.        9  Yellow  Fev.  of  New  York  in  1795. 

10  Essai  sur  la  Fievre  J.,  1st  ed.  71.         n  N.  Y.  J.  ii.  75,  N.  S. 

12  Second  Kept,  on  Quarantine  (Lond.),  57. 

13  Mem.  de  1'Acad.  de  Med.  xiv.  120.       u  Philad.  Med.  and  Phys.  J.  ix.  340. 

15  Memphis  Med.  Recorder,  i.  85-94;   see,  also,  Grant,  "The  Meteorology,  Sani 
tary  Condition,  Prevailing  Diseases,  and  Mortuary  Statistics  of  Memphis,"  Ameri 
can  J.  July  1853,  74,  115  ;  see,  also,  a  paper  by  the  same,  in  N.  0.  J.  for  May,  1852. 

16  Simons,  Charleston  J.  viii.  364. 


240  PNEUMONIA    AND 

house,  a  great  number  of  Irishmen  were  employed  in  excavating 
the  earth,  and  piling;  that  of  these  a  great  many  were  taken  sick 
and  died ;  and  that  the  sale  and  distribution  of  the  earth  through 
different  portions  of  the  city  had  a  baneful  effect.1  The  same  correct 
observer  states,  in  addition,  that  "  in  1849  an  extensive  drain  was 
opened  in  Ilasel  Street,  excavating  the  most  filthy  and  offensive 
materials ;  and,  likewise,  an  extensive  drain  in  Market  Street,  from 
Church  Street  to  the  wharf.  Yellow  fever  occurred  earliest  in 
those  localities,  and  was  more  fatal.  Again,  the  earth,  so  filthy  and 
offensive,  was  transferred  to  King's  Street,  from  Horlbeck's  Alley  to 
Ilasel  Street,  and,  in  this  particular  spot,  there  was  sickness  among 
a  class  of  persons  who  are  generally  exempt."2 

For  the  following  account  of  an  extensive  diffusion  of  autumnal 
fever  from  a  kindred  cause,  which  occurred  in  this  country,  we  are 
indebted  to  an  English  writer,  who  collected  the  information  on 
the  spot. 

The  digging  of  that  part  of  the  Chesapeake  and  Ohio  Canal 
which  runs  from  Seneka  to  Georgetown,  commenced  on  the  17th 
of  October,  1828,  and  was  nearly  finished  in  November,  1830.  The 
distance  is  about  twenty-three  miles,  and  for  the  greater  part  the 
canal  runs  nearly  parallel,  and  very  close  to  the  Potomac  Kiver. 
The  bank  of  the  canal  is  elevated  considerably  higher,  and,  in  some 
places,  as  much  as  fifty-four  feet  above  the  banks  of  the  stream, 
which  is  there  inclosed  in  a  hilly  country,  and  the  water  passes  on  to 
the  ocean,  with  all  the  rapidity  of  a  mountain  torrent.  During  the 
summer  of  1829,  there  were  nearly  four  thousand  labourers  em 
ployed  in  making  this  division  of  the  canal.  They  continued 
healthy  until  the  end  of  June;  but  in  July,  August,  and  September, 
they  suffered  severely.  During  these  months,  two  out  of  three  were 
attacked  with  autumnal  fever,  most  of  them  with  its  most  aggra 
vated  form,  and,  as  nearly  as  could  be  ascertained,  of  those  that 
were  taken  ill,  about  one-fifth  fell  victims  to  the  disease.3 

All  this  is  confirmed  by  what  Lind  pointed  out,  long  ago — that 
"  the  effluvia  from  ground  newly  opened,  whether  from  graves  or 
ditches,  are  far  more  dangerous  than  those  from  the  same  swampy  soil, 
where  the  surface  is  undisturbed ;  nay,  in  some  places,  it  has  been 
found  to  be  almost  certain  death  for  an  European  to  dig  a  grave  in 

1  Ibid.  365.  2  /k  cjG4,  5. 

3  Stevens  on  the  Blood,  239. 


AUTUMNAL    FEVERS.  241 

swampy  districts  of  tropical  climates,  unless  long  seasoned  to  the 
country.  In  such  a  place,  the  attendance  of  friends  at  funerals 
ought  to  be  dispensed  with."1 

The  construction  of  the  canal  of  the  Ourcq,  in  France,  in  the 
years  1810-13,  will  long  be  remembered  for  the  extensive  pre 
valence  of  fever,  of  which  it  was  evidently  the  cause,  and  the 
large  mortality  which  ensued  at  Pantin,  and  several  other  neigh 
bouring  villages.2  We  all  have  a  recollection  of  the  results  attend 
ing  the  digging  of  the  Carondelet,  and  other  canals  in  or  near  New 
Orleans,  and  in  other  parts  of  the  country.3  A  memorable  instance 
of  this  kind  occurred  in  France  in  the  latter  part  of  the  seventeenth 
century,  on  the  occasion  of  the  construction  of  the  aqueducts  and 
canals  required  for  conveying  water  to  Versailles  from  the  River 
Eure.  The  immense  upturning  of  earth,  which  was  effected  during 
very  hot  weather,  was  followed  by  a  large  amount  of  disease  and 
mortality  all  along  the  route,  but  more  particularly  about  the  Castle 
of  Maintenon,  where  the  principal  works  were  constructed.4 

Another  instance  of  a  more  recent  date,  is  worth  recording.  In 
the  small  commune  of  Lutzenbourg,  in  the  arrondissement  of  Sarre- 
bourg,  in  France,  the  population  of  which  did  not  exceed  six  hun 
dred  and  twenty-five,  remittent  fever,  preceded  by  a  vast  amount  of 
ague,  prevailed  during  July,  August,  and  September,  1852.  The 
spring  had  been  cold  and  wet ;  but  about  the  first  week  of  May,  the 
thermometer  suddenly  began  to  rise.  The  heat  steadily  increased, 
and  became  intense  in  July.  The  disease,  as  Avell  as  the  intermit- 
tents  which  preceded,  were  satisfactorily  traced  to  the  influence  of 
the  excavations  and  upturnings  of  earth  required  in  the  construction 
of  the  Paris  and  Strasburg  Railroad,  which  passes  through  the  com 
mune,  and  in  cutting  the  canal  connecting  the  Marne  with  the  Rhine, 
the  bed,  of  which,  from  the  stoppage  of  the  work,  had  been  con 
verted  into  a  boggy  marsh.  "  In  proportion,"  says  the  reporter,  "as 
the  public  works  extended  through  (Sillonnaient)  the  valley,  and  by 
upturning  the  earth,  brought  up  to  the  surface  the  deeper  layers  of 
the  soil,  so  intermittent  fevers  arose  and  spread  very  extensively." 
Prior  to  this,  the  population  had  been  healthy,  and  strangers  to 
malarial  fevers."0" 

1  Dis.  of  Hot  Climates,  108.  2  Villerme,  An.  D'Hyg.  xi.  352. 

3  Barton's  Rep.  to  State  Med.  Soc.  of  Louisiana,  34.     Thomas,  70,  1st  ed. 

4  La  Beanmelle,  Mem.  de  Mad.  de  Maintenon,  iii.  239,  240. 

5  Burchrmlt,  Gaz.   Med.  de  Strasburg,   December  25,   1852,    xii.   407.     The  esta- 

16 


242  PNEUMONIA    AND 

I  shall  have  occasion,  as  we  proceed,  to  mention  an  event  strik 
ingly  illustrative  of  the  injurious  effects  of  exhalation  from  open 
ditches,  which  occurred  at  the  General  Lying-in  Hospital  in  York 
Road,  Lambeth. 

The  following  case,  which  is  derived  from  Lancisi,1  will  be  read 
with  interest:  On  the  first  of  May,  1707,  the  hilly  grounds  to  the 
southward  of  the  town  of  Bagnarea,  after  continued  great  rains, 
began  to  fall  into  the  river  which  was  near  that  town,  in  such  a 
manner  that  whole  vineyards  were  moved  from  their  places,  and 
some  houses  entirely,  without  falling ;  in  one  of  them,  a  woman 
was  delivered  of  a  child  while  the  house  was  on  its  march.  The 
channel  of  the  river  was  choked  and  filled  up.  Many  cracks,  gaps, 
and  holes  were  left  in  several  parts  of  the  ground,  in  which  the 
waters  stagnated ;  and  they,  being  impregnated  with  sulphureous 
minerals,  with  which  the  earth  there  abounded,  became  exceed 
ingly  offensive  to  the  smell.  During  the  summer  heats,  the  colour 
of  the  inhabitants  became  of  a  dead  swarthy  yellow,  and  grievous 
pestilential  fevers  seized  them.  These  were  confined  to  the  southern 
and  lower  parts  of  the  town ;  while  the  other  parts,  which  stood 
high,  and  at  a  distance  from  the  stagnating  waters,  out  of  reach 
of  the  vapour  which  arose  from  thence,  remained  healthy,  as 
usual.  By  order  of  the  magistrates,  the  channel  of  the  river  was 

blishment  of  the  railroad  from  Strasburg  to  Basle,  has  required  the  digging,  to  the 
depth  of  1  to  2  metres  (from  3^  to  7  feet),  of  the  adjacent  fields,  with  the  view  of  pro 
curing  earth  with  which  to  level  the  road.  The  results  have  been  immense  excava 
tions  in  the  vicinity  of  the  communes  of  Bottwiler  and  of  Feldkirch.  After  being 
filled  with  water  in  the  autumn  and  spring,  these  excavations  become  partially  dried, 
and  deposit  a  large  quantity  of  slime.  They  have  thus  been  converted  into  true 
marshes,  in  which  M.  A.  Boumann  has  discovered  the  characteristic  plants  of  stag 
nant  water. 

Under  the  influence  of  this  marshy  surface  the  commune  of  Bottwiler,  the  popula 
tion  of  which  is  1446,  has  severely  suffered  from  intermittent  fever  during  the  last 
three  years.  In  1842,  the  number  of  fever  cases  amounted  to  36;  in  1844,  to  166  ;  in 
1845,  to  743  ;  and  in  1846,  to  1166.  The  mortality  has  increased  in  the  same  propor 
tion.  The  average  in  ten  years  (from  1836  to  1845)  is  36.  In  1846,  it  was  not  less  than 
54.  The  small  commune  of  Feldkirch,  with  a  population  of  450,  suffered  with  equal 
severity.  In  1843,  the  number  of  cases  amounted  to  2  ;  in  1844,  to  20  ;  in  1845,  to  135  ; 
and  in  1846,  to  376.  (Dollfus-Aussat.  Comptes  Rendus  de  1'Acad.  des  Sciences,  1847, 
xxiv.  779.)  M.  De  Gasparin  stated,  at  the  meeting  of  the  Academy  of  Sciences,  when 
this  report  was  read,  that  similar  effects  were  produced  by  analogous  changes  along 
the  railroad  of  Tarascon.  He  added  that,  when  informed  of  these  facts,  the  Minister 
of  the  Interior  ordered  the  marshes  to  be  filled  up.  Archives,  4th  series,  xiv.  241. 

1  Nox.  Palud.  Etfl.  lib.  2,  Epidem.  iii.  210,  211. 


AUTUMNAL   FEVERS.  243 

cleared,  drains  were  made  for  carrying  off  the  water,  the  places 
where  it  stagnated  were  cleared,  and  the  cavities,  which  could  not 
be  drained,  were  filled  up,  and  the  inhabitants  were  the  next 
summer  freed  from  the  fevers. 

In  the  public  thanksgiving  ordered  for  this  deliverance,  the 
Bishop  declared  the  obligations  they  were  under  to  Lancisi,  by 
whose  advice  they  had  been  delivered  from  such  poisonous  diseases. 

The  injurious  effects  resulting  from  the  receding  of  the  sea,  and 
the  consequent  extension  of  the  land  by  the  deposition  of  alluvion, 
have  been  noticed  at  the  mouth  of  the  Tiber,  of  the  Po,  of  the 
Ganges,  of  the  Oronoco,  of  the  Mississippi,  &c.  The  partial  revolution 
which  has  taken  place  in  the  first  of  these  localities,  as  is  remarked 
by  Dr.  Carriere,  has  not  resulted  merely  in  pushing  back  inland  the 
old  city  of  Ostia,  formerly  the  seaport  of  Rome,  and  separating  from 
the  sea  the  original  mouth  of  the  Tiber ;  it  has  placed  the  city  in 
the  centre  of  an  insalubrious  territory,  of  which  it  formerly  occupied 
only  the  edge,  and  has  been  the  cause  of  its  progressive  depopula 
tion.  We  know  that  formerly  Ostia  was  too  small  for  the  number 
of  its  inhabitants,  and  figured  among  the  magnificent  cities  of  La- 
tium.  At  present,  it  contains  only  a  priest,  a  tavern-keeper,  four  or 
five  soldiers,  and  a  few  families,  who  do  not  venture  even  to  reside 
there  all  the  year  round.  But  this  in  salubrity  is  not  limited  to  the 
city;  for,  inasmuch  as  the  miasmatic  elaboration  is  effected  on  a 
large  scale,  in  consequence  of  the  increased  extent  of  surface,  there 
has  arisen,  since  the  time  of  the  Romans,  a  new  source  of  morbific 
effluvia,  which  must  be  taken  into  account  when  we  inquire  into  the 
sanatory  conditions  of  the  country,  though  more  especially  when  the 
wind  blows  from  the  sea.1  Another  case  in  point  is  mentioned  b}r 
Sir  W.  Burnett.  In  former  days,  there  existed  a  large  marsh  near 
Malion.  It  has  now  been  converted  into  productive  gardens.  Since 
the  draining  of  the  greater  part  of  this  marsh  has  been  completed, 
the  sea  has  been  gradually  receding  from  the  head  of  the  harbour, 
leaving  ( particularly  during  the  prevalence  of  the  easterly  winds) 
a  large  portion  uncovered,  from  which,  in  the  summer  and  autumn, 
the  most  offensive  exhalations  proceed.2  I  have  already  alluded  to 
the  effect  of  the  annual  receding  of  the  Nile.  The  same  effect  re 
sults  from  the  diminished  extent,  noticed  every  year  at  particular 
periods,  in  certain  other  streams  and  bodies  of  water,  by  which  a 

1  Amer.  J.  July,   1851.     Carriere,  le  Climat  de  1'Itulie,  20,  21. 

2  Fevers  of  the  Mediterranean,  p.  14. 


244  PNEUMONIA    AND 

large  portion  of  their  banks  is  laid  bare.  The  River  Biviere,  and 
other  watercourses  in  Sicily,  lose,  yearly,  two-thirds  or  more  of 
their  dimensions ;  Lake  Cagliari,  in  Sardinia,  loses  almost  as  much. 
All  are  hotbeds  of  fever. 

Beneficial  effects  of  complete  drainage. — On  the  other  hand,  while 
everywhere  experience  has  demonstrated  the  injurious  effects  arising 
from  the  ordinary  mode  of  cultivating  rice — effects  which  have  called 
forth  in  several  places  the  protective  interference  of  governments1 
— the  physicians  of  Georgia  are  ready  to  tell  us  what  has  been  the 
result  of  the  dry-culture  system  on  the  health  of  localities  hereto 
fore  proverbial  for  their  sickliness.2  In  New  England,  and  other  parts 
of  this  country,  the  removal  of  mill-dams  has,  as  in  other  instances 
already  mentioned,  been  found  to  produce  the  like  salutary  effects. 
Several  of  the  cities  of  England  and  France  formerly  contained 
extensive  portions  of  marshy  ground,  and  other  sources  of  miasrnal 
exhalations,  and  were,  in  consequence,  annually  visited  by  remittent 
and  intermittent  fevers.  Many  of  these  marshes  have  been  com 
pletely  drained,  and  the  surface  built  upon,  or  otherwise  improved, 
and  the  disease  has  disappeared.  Thus,  for  example,  in  1558,  the 
mortality  from  such  fevers  in  London  was  so  considerable,  that  the 
living  could  hardly  bury  the  dead.  Less  than  a  couple  of  centuries 
ago,  that  city  was  subject  to  the  same  disease,  in  its  worst  forms. 
Bishop  Burnet's  authority  is  cited  for  the  fact,  that,  in  the  reign  of 
Mary,  intermittent  fevers  raged  like  a  plague.3  The  same  may  be 
found  in  the  writings  of  Sydenham  and  Morton.  From  1661  to 
1665,  the  annual  loss  from  intermittents  alone  averaged  more  than 
one  thousand.  Dr.  Short  informs  us  that  among  forty  deaths  from 
fever,  between  1628  and  1636,  one  was  from  ague.  "  There  are 
some  diseases  on  the  decline,"  he  says.  "Agues,  whereof  one  of  forty 
of  the  whole  that  died  of  fevers,  died ;  now  scarce  one  of  1,100  that 
die  of  fevers,  die  of  this.  This  distemper  has  at  several  times  pre 
vailed  for  a  long  series  of  years,  and  has  sometimes  raged  like  a 
plague.  In  1664  they  disappeared,  and  scarce  came  on  the  stage 
before  78 ;  but  from  1720  to  1729,  they  and  remittents  afflicted  the 

1  Monfalcon,  100;   Bourely,  Gaz.  Med.de  Montpellier,   Oct.  1840,  99;   ib.  Annalcs 
d'FIyg.  xliii.  328,  332;  Cycl.  of  Tract.   Mcd.  iii.  (50;  Williams  on  Morbid  Poisons,  ii. 
4:51 :   Boileau  Castclnau,  Annalcs  d'Hyg.  xliii.  331  ;   Delongchamp,  Diet,  dcs  So.  Med. 
xlix.  50,  7;  Zimmerman,  de  1'Experience,  ii.  402;  Fodere,  Mcd.  L6gale,  v.  1-33. 

2  Daniel,  29.  3  1Jlanc>  j.  254,  255. 


AUTUMNAL    FEVERS.  245 

whole  nation  grievously ;  and  now,  as  to  their  severity,  especially 
mortality,  they  are  extinct."1  Eernittents  and  intermittents  consti 
tuted,  as  it  would  appear,  no  inconsiderable  an  item  among  the  dis 
eases  which  Fothergill  noticed  in  London  during  certain  seasons  in 
1751-4.2  The  immense  marshes  which  were  situate  around  the 
city,  at  Lambeth  and  other  places,  were  removed  by  under-drains 
and  sewers ;  ditches  were  filled  up ;  the  river,  which,  from  Lambeth  to 
Woolwich,  was  swampy,  was  banked  out,  and  the  site  rendered  dry  by 
being  covered  with  buildings,  and  the  most  satisfactory  changes  in 
regard  to  salubrity  were  obtained.  In  1728,  the  deaths  from  these 
fevers  amounted  to  forty-four ;  in  1729,  to  forty-seven ;  and  in  1730,  to 
only  sixteen.  In  1752,  the  proportion  was  one  in  one  thousand  of 
deaths.  For  some  sixty  years,  the  disease  has  not  been  known  as 
an  endemic  in  that  metropolis ;  and  of  the  few  cases  that  occur,  the 
larger  number,  if  not  all,  are  traceable  to  fenny  districts,  situate  at 
a  greater  or  less  distance.3  A  similar  improvement  has  taken  place 
at  Portsmouth,  which,  in  former  days,  was  a  hotbed  of  intermittent 
fever;  but  has  been  freed  of  the  disease,  simply  by  paving  the  streets, 
and  removing  various  sources  of  miasrnal  infection.4  In  England, 
according  to  recent  reports,  of  the  fifty  cities  and  towns  in  which 
the  mortality  was  highest,  there  was  scarcely  one  in  which  drainage 
or  sewerage  was  complete.  In  seven,  it' was  indifferent,  and  in  forty- 
two  it  was  decidedly  bad.  Experience  there  has  shown  that  no 
population  is  healthy  which  live  amid  cesspools,  or  upon  a  soil  per- 

1  New  Observ.  Natural,   Moral,  Civil,  Political,,  and  Medical,  on  City,  Town,  and 
Country  Bills  of  Mortality,  &c.  208.     Lond.  1750. 

2  Weather  and  Diseases  of  London.— Works  i.  151,  210,  234. 

3  Dr.  Good,  and  his  commentator,  Mr.  Cooper,  have  called  attention  to  the  fact  that, 
in  1822  and  1823,  agues  again  made  their  appearance,  and  have  prevailed  ever  since 
more  frequently  than  they  had  done  for  many  years  before,  adducing  this  as  a  proof 
of  the  disease  arising  often  from  other  causes  than  malaria.     These  cases,  however, 
have  prevailed  principally  on  the  outskirts  and  not  the  centre  of  the  great  metropolis. 
Besides,  as  respects  London  and  its  vicinity,  changes  have  taken  place  sufficient  to  ex 
plain  the  circumstance  without  negativing  the  existence  of  malarial  effluvia.     Dr. 
Copland,  who  is  of  that  opinion,  calls  attention  to  the  fact  that  "the  streets  have  been 
macadamized,  constantly  watered,  and  covered 'by  a  wet,  clayey  mud;  the  soil  sur 
rounding  the  metropolis  has  been  turned  up  for  the  purpose  of  building,  &c.,  to  a  much 
greater  extent  since  that  period  than  formerly ;  and  the  muddy  and  marshy  banks  of 
the  river  have  been  unusually  disturbed  and  inundated  by  the  swell  from  the  paddles 
of  the  numerous  steam  vessels." — Copland  i.  1090,  Am.   ed. 

4  See  British  &  For.  Med.  R.  i.  286.     See,  also,  Baker  on  Intermittents,  Med.  Trans, 
of  College  of  Phy.  of  London,  iii.  141,  &c.  ;   Willan's  Reports,  203. 


246  PNEUMONIA    AND 

meated  by  decomposing  animal  or  vegetable  refuse,  giving  off  impu 
rities  to  the  air  in  their  houses,  and  in  the  streets ;  and  experience 
has  proved,  also,  that  in  those  places  where  such  sources  of  impu 
rity  are  removed,  the  salubrity  improves.  From  this,  we  may  infer 
that  a  late  writer  is  not  far  from  the  truth,  when  he  avers  that  inter- 
mittents  have  nowadays  become,  to  the  profession  at  large,  mate 
rials  for  medical  history,  rather  than  for  medical  observation ;  since 
it  is  a  rare  fact,  in  many  places,  to  meet  with  a  case.  If  they  appear 
at  all,  it  is  in  marshy  districts,  some  of  which  exist  still,  and  must 
long  continue  to  do  so,  or  in  such  places  as  along  the  Surrey  bank 
of  the  river — from  Battersea  to  Deptford,  where  a  great  part  of 
the  surface  is  lower  than  high-water  mark,  and  the  ground  conse 
quently  is  never  well  drained.1 

In  the  Island  of  Ely  (England),  the  mortality,  as  compared  with 
the  births,  was  formerly  as  70  to  61.  The  island  has  been  drained; 
and  we  learn  from  Sir  John  Sinclair,  that  the  proportion  is  now  as 
54  to  61.  Dr.  Kirkland,  who  practised  for  thirty  years  at  Chelm- 
ford,  situate  in  a  marshy  district  of  country,  called  the  Hundred 
of  Essex,  states  that,  in  former  days,  the  inhabitants  were  all  pale, 
jaundiced,  emaciated,  and  bore  in  every  way  strong  marks  of  the 
effects  of  malaria.  Fever  prevailed  extensively  among  them,  and 
hardly  any  stranger  could  venture  to  the  place.  Through  the 
instrumentality  of  philanthropic  and  enterprising  individuals,  the 
country  has  been  drained,  improved,  and  cultivated;  fevers  have 
disappeared  or  greatly  lessened,  and  the  inhabitants  are  as  remark 
able  for  their  fine  health  and  fine  looks,  as  they  were  before  for  the 
reverse.2 

Dr.  Rigby,  in  his  examination  before  the  commissioners  on  the 

1  London  Medical  Gazette,  xxiii.  870. 

2  Sinclair,  The  Code  of  Health  and  Longevity,  41,  42.     London,  1820. 

Mr.  John  Marshall,  Jr.,  in  a  report,  sa}rs:  It  has  been  shown  that  tlie  Isle  of 
Ely  was  at  one  period  in  a  desolate  state,  being  frequently  inundated  bv  the  upland 
waters,  and  destitute  of  adequate  means  of  drainage ;  the  lower  parts  became  a 
wilderness  of  stagnant  pools,  the  exhalations  from  which  loaded  the  air  with  pestife 
rous  vapours  and  fogs  ;  now,  by  the  improvements  which  have  from  time  to  time 
been  made,  and  particularly  within  the  last  fifty  years,  an  alteration  has  been  made 
which  may  appear  to  be  the  effect  of  magic.  By  the  labour,  industry,  and  spirit  of 
the  inhabitants,  a  forlorn  waste  has  been  converted  into  pleasant  and  fertile  pastures, 
and  they  themselves  have  been  rewarded  by  bounteoiis  harvests.  Drainage,  embank 
ments,  engines,  and  inclosures,  have  given  stability  to  the  soil  (which  in  its  nature  is 
as  rich  as  the  Delta  of  Egypt)  as  well  as  salubrity  to  the  air. — C/tadicick,  2d  Re 
port,  Fol. 


AUTUMNAL    FEVERS.  247 

state  of  large  towns,1  says  of  the  General  Lying-in  Hospital,  in 
York  Eoad,  Lambeth :  "  The  hospital  was  seldom  free  for  any 
length  of  time  from  puerperal  fever,  occasionally  producing  fright 
ful  ravages,  and  requiring  the  building  every  now  and  then  to  be 
closed.  After  the  greatest  attention  had  been  paid  to  cleanliness  in 
every  respect,  the  wards  left  open  night  and  day  for  weeks,  fumi 
gated,  the  walls  limed  and  painted,  the  beds  thoroughly  cleaned, 
fumigated,  repaired,  and  frequently  renewed,  and  the  most  scrupu 
lous  attention  paid  to  cleanliness,  the  fever  reappeared,  on  some 
occasions  immediately,  on  the  hospital  being  reopened.  This  cir 
cumstance  made  us  look  to  external  causes,  when  we  ascertained 
that,  in  the  immediate  vicinity  of  the  hospital,  there  were  upwards 
of  1,500  feet  of  open  ditches,  receiving  the  drainage  of  the  poor 
and  dense  population  of  the  neighbourhood,  one  of  the  ditches 
being  not  more  than  thirty  feet  from  the  wall  of  the  building.  It 
was  black  and  stagnant,  and  in  constant  ebullition  from  the  dis 
engagement  of  gas.  After  great  difficulty  and  trouble,  the  hospital 
having  to  bear  a  large  proportion  of  the  expense,  the  Commission 
ers  of  Sewers  were  induced,  although  with  much  reluctance  (in  Oct. 
1838),  to  have  a  portion  of  these  ditches  cleaned  and  properly 
arched  over ;  an  immense  quantity  of  black  pestilential  mud  was 
excavated,  but,  instead  of  being  removed,  it  was  spread  over  the 
adjoining  ground.  The  effect  was,  that  "  at  that  time  the  hospital 
was  freed  from  disease,  but  ten  cases  of  puerperal  fever  occurred 
within  twenty-four  hours  after  this  unjustifiable  act."  The  drainage 
of  the  hospital  was  then  carefully  attended  to,  and  ventilation  also 
(the  main  drain  had  been  entirely  blocked  up  by  two  logs  of  wood), 
and  puerperal  fever  ceased. 

It  appears,  from  the  statistical  accounts  of  Scotland,  that  the 
effects  of  drainage  in  various  counties  have  been  very  beneficial  to 
the  health  of  the  population.2  There  is  not  much  intermittent  fever 
in  Edinburgh,  but  there  was  formerly  a  lock,  called  North  Lock, 
which  was  famous  for  it.  Ague,  remittents,  and  intermittents  pre 
vailed  in  that  district  till  the  spot  was  drained.3  They  now  no 
longer  appear.  The  following  facts  are  recorded  in  the  Parliament 
ary  Reports.  In  Fordown  County:  "So  much  draining  that  now 
no  swamps;  formerly,  agues  common;  now  quite  unknown."  Kin- 

1  First  Report,  412. 

2  Second  Kept,  of  the  Lond.  Coramis.  for  1848,  p.  43. 

3  Elliotson's  Lectures,  Lond.  Med.  Gaz.  ix.  890. 


248  PNEUMONIA    AND 

ross-Kinross  :  "Agues  prevalent  sixty  years  ago,  in  consequence  of 
marshes;  now  never  met  with."  Oswell:  "Ague  prevalent  for 
merly,  bat  not  since  the  land  was  drained."  Redgorton;  "Healthy; 
no  prevailing  disease;  ague  was  frequent  formerly,  but  not  since 
the  land  has  been  drained  and  planted."  Albernyte :  "  Since  the 
land  was  drained,  scrofula  rare,  and  ague  unknown."  Muckhart : 
"  Great  improvement  in  agriculture ;  ague  formerly  prevalent ; 
not  so  now."1 

Mr.  Smith  states,  in  answer  to  questions  put  to  him,  at  the  re 
quest  of  the  Metropolitan  Sanitary  Commissioners,  that  in  the 
alluvial  clay  district  of  Stirlingshire,  and  west  of  Perthshire,  where 
the  drainage  was  formerly  effected  by  large  open  ditches,  in  the 
Dutch  fashion,  ague  was  periodically  prevalent,  and  rheumatism, 
fevers,  and  scrofulous  affections  were  much  promoted,  until  the 
introduction  of  thorough  drainage,  forty  years  ago;  after  which 
period  those  diseases  began  to  disappear,  or  to  be  greatly  mitigated 
in  severity.  "  Few  cases  of  ague  now  appear.  Fevers  are  seldom 
known,  except  in  the  usual  course  of  fevers  which  prevail  epidemi 
cally  over  the  whole  country.  In  the  undrained  condition  of  those 
districts,  they  were  subject  to  dense  fogs,  especially  in  the  autumnal 
months,  when  much  rain  had  fallen,  communicating  a  chilly  feeling 

1  Dr.  Southward  Smith,  before  a  committee  of  the  House  of  Commons,  declared: 
"  That  in  every  district  in  which  fever  returns  frequently,  and  prevails  extensively, 
there  is,  uniformly,  bad  sewerage  ;  a  bad  supply  of  water ;  a  bad  supply  of  scaven 
gers,  and  a  consequent  accumulation  of  filth.  If  you  trace  down  the  fever  districts 
on  a  map  of  the  Commissioners  of  Sewers,  you  will  find  that,  wherever  they  have  not 
been,  the  fever  is  prevalent;  and,  on  the  contrary,  where  they  have  been,  lever  is  com 
paratively  absent." 

In  the  Ifolywell  and  Long  Alley  district,  with  five  hundred  recorded  cases  of 
diarrhoea  and  typhus,  within  the  last  six  months,  in  one  particular  place,  namely, 
Long  Alley — which  is  a  long,  narrow,  and  close  passage,  crowded  with  inhabitants — 
the  drainage,  contrary  to  the  general  rule,  has  been  put  in  good  order,  and  this 
place  has  remained  exempt  from  disease.  Two  courts  in  Whitechapel,  that  were 
iu  an  exceedingly  damp  arid  filthy  condition,  and  in  which  fever  had  prevailed  for 
some  time  in  every  house,  ceased  to  be  affected  with  disease  on  being  drained.  In 
Dulwich,  fever  was  arrested  by  clearing  out  drains.  In  Hammersmith,  diarrhoea  dis 
appeared  in  one  street  after  the  emptying  of  a  cesspool  that  had  overflowed,  a  new- 
drain  having  been  built  at  the  same  time.  In  the  Acton  district,  no  fever  is  reported, 
and  only  ten  cases  of  diarrhoea,  the  external  and  internal  cleansing  having  been  well 
attended  to. — Metropolitan  Kanilar;/  Coininixxior),  'Id  Report  (1848),  22. 

"  It  is  reported  to  us  that  agues  and  remittent  fevers,  in  Gravesend  and  the  vici 
nity,  luivo  been  greatly  reduced  after  the  drainage,  although  very  imperfect,  which 
has  been  accomplished  in  the  town  and  neighbourhood. — Id  Report  of  London  Com- 
luixtsioncrs  (1848),  42. 


AUTUMNAL    FEVERS.  249 

to  the  inhabitants ;  but  since  the  general  introduction  of  thorough 
draining,  those  fogs  seldom  prevail,  unless  in  a  general  foggy  tend 
ency  of  the  atmosphere  of  the  country/' 

On  the  farm  of  Deanston,  in  the  west  of  Perthshire,  consisting 
of  about  200  acres,  and  which  was  the  first  farm  on  which  the  entire 
system  of  thorough  drainage  and  subsoil  ploughing  was  introduced, 
there  was  a  marked  effect  produced.  The  farm,  after  periods  of 
rain,  used  to  be  covered  with  chilly  fogs,  which  entirely  disappeared 
after  the  thorough  draining  was  effected. 

Mr.  Parker  reports  :  "In  respect  of  increased  salubrity,  induced 
in  towns  and  rural  districts  by  drainage,  I  may  instance  the 
acknowledged  disappearance  of  ague  and  other  periodical  maladies 
consequent  on  the  great  drainage  effected  in  Cambridgeshire,  as  in 
the  Isle  of  Ely,  &c.,  and  in  the  Lincolnshire,  and  other  great 
marshes.  As  an  example  of  the  good  effects  arising  from  the 
drainage  of  swamps,  I  may  state  that  the  Commissioners  of  Her 
Majesty's  Woods  and  Forests,  of  which  your  lordship  is  the  chief, 
have  recently  caused  me  to  drain  an  extensive  tract  of  country  in 
the  new  forest,  called  the  Wear's  Lawn  and  Bog,  adjoining  which  is 
a  small  hamlet,  where  inhabitants  previously  suffered  much  from 
intermittent  fevers.  The  hamlet  is  now  healthy ;  the  offensive, 
gaseous  emanations  from  the  soil  have  ceased  ;  and  the  inhabitants 
are  supplied  with  an  abundance*  of  the  purest  spring  water,  dis 
covered  during  the  operations  of  drainage,  and  appropriated  to 
their  use." 

A  Mr.  Xeilson  remarked:  "I  have  also  had  several  opportunities 
of  witnessing  similar  effects  in  the  West  Indies,  and  particularly  in 
British  Guiana,  where  I  resided  several  years.  The  surface  is 
almost  a  dead  flat,  lower  than  the  sea  at  high  water,  and  drained 
only  at  considerable  expense  by  large  sluicegates  for  each  estate, 
which  are  opened  each  period  of  low  water.  When  an  estate  is 
abandoned,  this  is  neglected,  and  its  neighbourhood  is  invariably 
the  first  to  suffer  on  the  approach  of  an  epidemic;  and  I  have 
known  instances  of  the  course  of  a  fever  thus  produced  being 
checked,  and  materially  altered,  by  the  neighbouring  lands  being 
drained,  an  alteration  considerably  accelerated  by  a  small  quantity, 
of  lime,  in  a  finely  powdered  state,  being  distributed  on  the  lands 
during  a  windy  day."1 

1  Drainage  of  the  Lruul  Forming  the  Sites  of  Towns,  00-72.     London,  1802. 


250  PNEUMONIA    AND 

According  to  Dr.  Graves,  whose  premature  loss  to  the  profession 
we  must  all  greatly  deplore,  there  can  be  no  doubt  that  in  Ireland, 
as  in  other  countries,  the  effects  of  cultivation  and  drainage  on  the 
health  of  the  inhabitants  are  very  remarkable.  He  himself  witnessed 
several  exemplifications  of  the  improvements  thus  effected  in  respect 
to  the  public  health.  Formerly,  ague  was  of  rather  common  occur 
rence  in  some  marshy  districts  in  the  immediate  vicinity  of  Dublin, 
and  consequently,  when  he  was  a  pupil,  cases  of  intermittent  fever 
were  constantly  to  be  met  with  in  the  hospitals;  now,  the  low 
grounds  have  been  drained,  and  thus  the  production  of  ague  has 
been  entirely  arrested.1 

The  city  of  Cork,  Ireland,  lies  in  an  irregular  valley  which  is 
open  to  the  east  and  west,  but  is  confined  by  hills  on  the  north  and 
south  sides.  On  the  west  it  is  connected  with  the  fertile  valley  of 
the  Eiver  Lee,  which,  rising  from  the  mountain  lake  of  Gongane 
Barra,  flows  in  a  devious  course  until  it  reaches  the  city  of  Cork, 
where  it  receives  a  large  tidal  accession.  When  the  Lee  is  about 
a  mile  west  of  the  city,  it  divides  into  two  channels,  which  gradually 
diverge,  but  reunite  again,  thereby  insulating  a  considerable  tract, 
upon  which  the  main  part  of  the  city  is  built.  This  tract  is  low, 
and  being  permeated  by  some  small  streams  from  the  main 
branches,  inundations  occur  when  the  river  is  swollen  by  heavy 
rains  and  high  tides.  From  this*  cause  the  city  anciently  derived 
its  not  very  flattering  name,  Corkagh,  signifying  a  morass.  This 
unpromising  locality,  from  its  marshy  nature,  was,  as  might  be 
expected,  very  subject  to  intermittent  fever,  and  "  the  fever  and 
ague"  were  as  familiar  words  in  Cork  as  they  are  in  the  swamps  of 
the  Mississippi.  Within  the  last  century  it  has  been  drained,  and 
in  part  built  upon.  The  smaller  inosculating  channels  have  been 
arched  over ;  the  river  has  been  confined  by  handsome  quays  to  its 
two  divisions,  and  the  main  branches  have  been  deepened.  The 
effect  has  been,  the  almost  disappearance  of  the  fever,  which  now 
shows  itself  but  seldom,  and  for  a  number  of  years  did  not  reign  in 
an  epidemic  form.2 

In  fact,  so  far  as  Great  Britain  is  concerned,  the  immense  benefit 
of  drainage  has  been  proved  by  all  the  researches  of  Mr.  Chadwick, 
who  says:  "In  considering  the  circumstances  external  to  the  resi- 

1  Cliiiiral  Lectures,  51,  Am.  ed. 

2  Poplmm,  Notes  on  the  (Miniate  and  Diseases  of  the  City  of  Cork,  Dublin  .Journal 
of  Med.  Sc.  xv.  290,  May,  1853. 


AUTUMNAL   FEVERS.  251 

dence,  which  affect  the  sanitary  condition  of  the  population,  the 
importance  of  a  general  land  drainage  is  developed,  by  the  inquiries 
as  to  the  causes  of  the  prevalent  diseases,  to  be  of  a  magnitude 
of  which  no  conception  had  been  formed  at  the  commencement  of 
the  investigation;  its  importance  is  manifested  by  the  severe  conse 
quences  of  its  neglect  in  every  part  of  the  country,  as  well  as  by  its 
advantages  in  the  increasing  salubrity  and  productiveness,  wherever 
the  drainage  has  been  skilful  and  effectual.1 

Lancisi  gives  a  memorable  instance  of  this  in  the  town  of  Gon- 
dolpho,  already  referred  to,  which,  notwithstanding  its  elevation, 
was  rendered  sickly  by  the  exhalations  from  Lake  Turnus,  lying 
below  it  to  the  south-west.  The  lake  was  dried  up,  by  order  of 
Pope  Paul  V.,  and  salubrity  was  the  consequence.2  The  same 
writer  relates  an  interesting  case  of  the  beneficial  effect  of  drainage, 
which  was  communicated  to  him  by  Lentilius,  physician  to  the 
Duke  of  Wurtemberg,  and  which  occurred  at  Stutgard.  "  What 
you  are  preparing,  on  the  noxious  exhalations  of  marshes,"  says 
Lentilius,  "  cannot  but  be  entertaining  and  useful.  No  one  can 
doubt  of  the  great  importance  of  the  subject.  This  I  can  illustrate 
by  a  single  statement :  Stutgard,  the  residence  of  my  most  serene 
Prince,  is  surrounded  by  mountains  on  every  side  except  the  east, 
where  there  is  a  sort  of  plain,  stretching  about  an  hour's  walk 
towards  the  Elver  Necker.  Near  the  wall  of  the  town,  on  the 
eastern  side,  and  near  that  plain,  was  formerly  a  fish-pond  or  pool 
of  several  acres  in  extent.  For  many  years,  our  metropolis  has 
been  notorious  for  its  obstinate  quotidian  intermittents,  which, 
being  scarcely  epidemic,  but  only  endemic,  have  been  commonly 
known  by  the  name  of  the  Stutgard  fevers.  It  happened,  about 
fifteen  years  ago,  that  this  pool  was  drained,  and  converted  into  a 
most  beautiful  meadow.  From  that  time,  intermittent  fevers  have 
become  so  rare  that  they  never  once  have  deserved  the  name  of 
epidemic,  but  only  appear  in  sporadic  cases,  here  and  there,  and 
are,  moreover,  much  easier  to  cure.  Hence,  it  appears  that  the 
fevers  arose  from  the  filthy  effluvia  of  the  pool,  wafted  by  the 
eastern  wind  over  the  town,  and  confined  there  by  the  inability  of 
the  wind  to  sweep  them  quite  away,  on  account  of  the  mountains 
adjacent."3 

1  Second  Kept,  Fol. 

2  De  Xoxiis  Palhulum  Effluviis,  20.  3  Ibid.  10. 


252  PNEUMONIA   AND 

M.  Huguenin,  in  a  Prize  Essay  on  Ponds,  which  was  presented 
to  the  Academy  of  Lyons  in  1778,  and  is  quoted  in  the  Memoirs 
of  the  Koyal  Medical  Society  of  Paris  (vol.  viii.  p.  289),  after  dwell 
ing  on  the  injurious  influences  of  marshes,  says:  "Lorraine  long 
experienced  these  baneful  effects,  before  the  cause  of  the  periodic 
return  of  the  fatal  febrile  diseases,  by  which  it  was  visited  during 
several  successive  centuries,  could  be  ascertained.  While  its  hu 
mane  and  benevolent  princes  founded  thousands  of  charitable  insti 
tutions  to  insure  relief  against  these  ever-renewed  evils;  while 
natural  philosophers  and  physicians  laboured  to  discover  the  germ 
of  those  disastrous  epidemic  diseases,  agriculture  came  to  the  aid 
of  this  desolated  province,  and,  without  suspecting  the  miracle  it 
was  about  performing,  drained,  in  a  short  time,  two  hundred  ponds, 
in  order  to  fecundate  the  precious  soil  which  had  so  long  been  ab 
sorbed  by  the  water.  The  air  being  thereby  relieved  of  the  humid 
ity  and  putrid  vapours  by  which  it  had  been  heretofore  saturated,  a 
stop,  or  at  least  an  interruption,  was  put  to  this  fatal  circle  of  con 
tagions,  which,  while  endemic  in  localities  surrounded  by  ponds, 
appeared  often  epidemically  in  the  rest  of  the  province." 

In  Paris,  malarial  fevers,  in  the  time  of  Ballon ius,  were  of  daily 
occurrence,  and  prevailed  on  a  large  scale.  They  have  now  become 
so  rare  that  when  Alibert  wrote  his  once  popular  treatise,  it  was 
with  difficulty  he  could  find  more  than  a  few  cases  for  examination. 
Strasburg,  already  mentioned,  has,  in  like  manner,  been  cured  of 
such  diseases,  except  in  some  parts  of  the  suburbs;  but  here, 
marshes  have  been  allowed  to  remain  unreclaimed.  Like  results, 
though  not  invariably  so  entirely  satisfactory,  have  been  obtained 
in  other  parts  of  France;  as,  for  example,  at  Eochefort,  Marenne,1 
Bresse,2  Lome,3  Bourg,4  Monbrison,5  Fours,6  Lyons,7  Bourgoin,8  &c. 
If  the  first  of  those  cities — which,  in  the  days  of  Chirac,  was  pro 
verbial  for  its  unhealthiness,  and  was  visited,  in  1694,  by  a  wide- 
spreading  and  malignant  epidemic,  of  which  that  most  distinguished 
physician  has  left  us  a  vivid  description — still  suffers  from  fevers  in 
autumn,  the  effect  is  due,  not  to  the  persistence  of  palludnl  influ 
ences  within  its  walls,  or  in  the  immediate  vicinity,  but  to  other 
circumstances  already  adverted  to. 

1  Melier,  Mem.  de  1'Acad.  de  Medccine  xiii.  073. 

2  Statistiquc  du  Depart,  de  1'Ain,  184;    Fodere,  Med.  Legale,   v.  251. 

3  faultier  de  Olaubry,  Mem.  de  1'Acad.  de  Med.  xiv.  129. 

4  Morifalcon,  32.         5  Ib.  42.         6  Ib.  184.         ?  Ib.  182.        8  Ib.  182. 


AUTUMNAL    FEVERS.  253 

The  present  beautiful  city  of  Bordeaux  was  so  sickly  formerly — 
so  frequently  and  fearfully  visited  by  periodic  fevers,  arising  from 
the  exhalation  of  extensive  marshes,  situate  in  the  vicinity — that 
the  Parliament  of  the  Province,  which  held  its  meeting  there,  was 
often  compelled  to  seek  shelter  in  other  and  more  favoured  locali 
ties.  Such  was  the  case  in  1473, 1495,  1501,  1515, 1525, 1546,  1653, 
and  1654;  on  which  occasions,  the  disease  assumed  a  more  malignant 
form  than  common,  and  was,  according  to  the  custom  of  the  times, 
held  in  the  light  of  a  plague.  Similar  events  would,  probably,  have 
continued  to  occur,  had  not  a  venerable  prelate,  the  Cardinal  de 
Sourdis,  then  bishop  of  the  Province,  formed,  in  1604,  the  project — 
which  he  carried  into  effect  at  his  own  expense — of  draining  and 
reclaiming  the  larger  portion  of  the  marshes  situate  near  the  city. 
This  gigantic  work  was  effected ;  and  fevers,  since  then,  have  seldom 
if  ever  visited  that  city — never,  in  that  part  of  it  which  had  been 
more  particularly  under  the  influence  of  the  culprit  marshes.  Other 
similar  works,  in  other  parts  of  the  city  or  the  vicinity,  have  been 
effected,  and  always  with  the  same  happy  results.1 

1  Betbeder,  Topogr.  Med.  de  la  villc  de  Bordeaux,  Mem.  de  la  Soc.  Roy.  de  Med. 
i.  187  ;  see  also  same  work,  viii.  270  ;  Yillerme,  An.  d'Hyg.  xi.  840.  The  ponds  of  the 
Dombes,  as  already  mentioned,  have  long  been  noted  for  the  insalubrity  they  occasion. 
In  1830,  the  sickness  in  the  vicinity  was  so  great  that  a  commission  was  appointed 
to  suggest  measures  for  remedying  the  evil.  In  his  report  on  the  subject,  M.  Purvis 
says :  "  Almost  every  individual  examined  admitted  the  baneful  effects  of  the  ponds  : 
a  large  number  viewed  them  as  the  principal  cause ;  a  small  number  referred  the 
eft'ect  to  the  nature  of  the  soil ;  others,  to  the  marshy  condition  of  the  fields,  &c." 
At  the  same  time,  a  large  amount  of  facts  were  adduced  in  the  course  of  the  inquiry, 
tending  to  show  that  the  salubrity  of  the  place  was  restored  whenever  the  ponds  were 
dried  up.  The  commission,  in  view  of  the  numerous  facts  obtained  during  the  inquiry, 
— influenced  by  the  advice  of  all  the  physicians  who  have  turned  their  attention  to 
questions  of  public  health,  and  of  all  the  agriculturists  and  economists  who  have 
written  on  the  subject — taking  into  consideration  that  the  Dombes,  before  the  increase 
in  the  number  of  ponds,  was  much  more  extensively  cultivated  and  more  populous  than 
since  they  have  been  made  to  occupy  a  large  portion  of  the  soil ;  that  since  then 
more  than  one-half  of  the  population  seem  to  have  disappeared ;  that  while  the  Bresse, 
the  formation  of  which  is  similar  to  that  of  the  Dombes,  with  an  inferior  and  unhealthier 
soil,  has,  by  drying  up  its  ponds,  enhanced  its  prosperity,  and  possesses  now  a  popula 
tion  of  1,600  inhabitants  to  every  square  league  ;  the  Dombes,  on  the  contrary,  by 
multiplying  hers,  has  lessened  greatly  the  net  value  of  her  agricultural  products,  and 
has  now  a  population  of  less  than  400  to  the  square  league  ; — considering,  finally,  that 
insalubrity  and  fevers  reappear  everywhere  with  the  increase  of  ponds,  and  that  com 
monly  salubrity  is  everywhere  restored  when  these  are  dried  up,  the  commissioners 
are  unanimous  in  the  opinion  that  the  ponds  are,  without  the  least  doubt,  the  princi 
pal  cause  of  the  insalubrity  of  the  Dombes."  They  admit  that  marshy  fields,  bad 


254:  PNEUMONIA    AND 

Surrounded  as  Copenhagen  and  all  Denmark  are  by  water,  salt 
and  fresh,  and  situate,  as  the  former  is,  in  a  low  and  flat  country, 
containing  much  stagnant  water  and  many  ditches,  it  is  no  wonder 
that  ague  is  of  very  common  occurrence  there.  Yet  the  disease,  as 
we  learn  from  Professor  Otto,  "  is  much  less  frequent  now  than 
formerly,  which  must  be  attributed  to  the  draining  of  several  pools 
and  stagnant  waters.  The  ague  was,  at  one  time,  from  the  want  of 
proper  drainage,  extremely  frequent,  and  in  many  cases  fatal,  on 
the  island  of  Langland."1 

Around  Scanderoon,  the  seaport  of  Aleppo,  are  extensive  marshes 
and  swamps,  which  produce  their  usual  effects.  "  During  the  sway 
of  Ibrahim  Pasha  in  the  country,  it  was  brought  before  his  notice. 
Attracting  as  it  did  so  much  attention,  the  whole  was  drained,  and 
canals  formed  to  carry  off  the  waste  water  continually  from  the 
hills,  &c.  For  two  years  subsequent  to  the  completion  of  these 
salutary  exertions,  an  almost  perfect  immunity  was  enjoyed ;  but 
the  soldiers,  at  the  commencement  of  the  operations  in  1840,  de 
stroyed  the  embankments,  &c.,  and  soon  reconverted  what  had 
become  cultivated  land  into  their  former  state,  and  the  disease, 
which  had  almost  been  banished  from  the  neighbourhood,  again 
resumed  as  severe  a  sway  as  formerly."2 

As  cities  enlarge  and  improve,  malarial  fevers  decrease  in  them. — In 
our  own  cities — the  larger  ones  particularly- — remittent  and  inter- 
regimen,  and,  perhaps,  the  nature  of  the  soil,  have  some  agency  in  producing  that 
effect ;  but  they  believe  that  all  those  causes  combined  are  far  from  being  capable  of 
occasioning  a  degree  of  evil  equal  to  that  occasioned  by  the  ponds.  (Statistique  du  De 
partment  de  1'Ain,  quoted  from  Becquercl  on  Climate,  278.)  The  commune  of  Varenge- 
ville,  in  the  arrondissement  of  Dieppe  (Seine  Iriferieure),  is  situate  on  a  surface  which 
formerly  constituted  part  of  a  large  marshy  district  noted  for  its  unhealthiness,  and  was 
the  frequent  seat,  during  the  autumn,  of  epidemics  of  intermittent  fever.  On  one 
occasion,  the  almost  entire  population — 177  out  of  182 — suffered  simultaneously  or 
in  succession.  Their  general  health  was  bad ;  they  presented  signs  of  a  cachectic 
state,  and  all  the  morbid  conditions  resulting  from  frequent  attacks  of  intermittent 
fever.  The  duration  of  life  among  them  was  short.  Considerable  ameliorations  have 
been  effected  in  the  condition  of  this  locality  during  the  last  sixty  years.  A  great 
part  of  the  marshy  surface  has  been  drained  and  converted  into  cultivated  fields,  and 
periodic  fevers  have  diminished  or  disappeared.  In  some  parts,  however,  and  espe 
cially  in  the  small  commune  of  Varengcville,  little  or  nothing  has  been  done  to  reclaim 
the  land  and  marshy  surfaces,  and  stagnant  pools  continue  to  exist ;  and  wherever 
such  is  the  case,  fevers  continue  to  prevail.  (Mem.  de  1'Ac.  de  Med.  xiv.  118.) 

1  Topogr.  of  Copenhagen.    Trans,  of  the  Provincial  Mcd.  and  Surg.  Assoc.  vii.  205. 

2  Robertson,  Med.  Notes  on  Syria,  Ed.  J.  Ix.  38. 


AUTUMNAL    FEVERS.  255 

mittent  fevers  are  limited  to  the  suburbs.  As  the  buildings  extend 
out,  and  the  closely  inhabited  portions  expand,  and,  by  so  doing, 
lessen  the  area  of  humid  and  exposed  soil,  the  disease  recedes. 
Charleston,  Savannah,  New  York,  Buffalo,  Auburn,  Geneva,  Syra 
cuse,  Salina,  and  Louisville,  &c.  may  be  appealed  to  in  illustration 
of  this.  The  statement  of  Professor  Yandall,  relatively  to  the  latter 
city,  are  apposite.  The  rock,  of  which  the  subsoil  is  composed, 
"  forms  a  surface  remarkable  for  its  evenness ;  and  the  soil  which  it 
produces,  as  it  crumbles  under  the  action  of  the  air,  frost,  and  water, 
is  peculiarly  retentive  of  moisture.  Ponds  and  slushes  are  abund 
ant,  wherever  the  black  slate  constitutes  the  surface-rock.  The 
first  houses  erected  at  the  fall  were  built  in  the  midst  of  ponds. 
Entire  squares  of  the  city  are  now  pointed  out,  which  occupy  the 
ancient  beds  of  ponds,  large  and  deep  enough  to  float  a  steamboat. 
These  have  all  been  drained,  and  such  collections  of  water  are  no 
where  to  be  seen  within  the  city  limits."  Louisville,  while  it  stood 
amid  its  ponds,  Dr.  Yandall  remarks,  "  was  regarded  as  one  of  the 
most  sickly  towns  in  the  Valley  of  the  Mississippi.  It  was  com 
monly  called  '  The  Graveyard  of  the  West?  It  is  now  esteemed  one  of 
the  most  healthy.  Intermittent  fever  was  a  regular  annual  visitant, 
and  occasionally  a  form  of  bilious  fever  prevailed,  rivalling  yellow 
in  malignity,  and  threatening  to  depopulate  the  town.  The  most 
fatal  of  these  endemics  broke  out  in  1822,  after  a  hot,  rainy  season. 
The  number  of  victims  from  it,  out  of  a  population  of  less  than  five 
thousand,  was  two  hundred  and  thirty-two.  In  a  family  consisting 
of  twenty  persons,  nineteen  were  sick  at  one  time,  and,  in  some 
families,  every  individual  died.  At  this  time,  only  one  street  in 
Louisville  was  paved,  and  within  its  limits  were  at  least  eight  ponds 
of  greater  or  less  dimensions,  most  of  which,  in  the  course  of  the 
autumn,  were  dried  up,  exposing  foul  bottoms  to  the  sun.  "  The 
ponds  have  all  disappeared.  The  streets  have  generally  been 
paved,  and,  though  the  grading  is  defective,  and  can  never  be  as 
effectual  for  drainage  as  it  might  be  rendered  on  a  less  even  sur 
face,  still,  it  is  such  as  to  carry  off  the  rains  into  the  river,  and  the 
ditches  south  of  the  city.  The  only  parts  of  Louisville  obnoxious 
to  the  charge  of  unhealthfulness,  are  its  suburbs.  Beargrass,  a 
small  sluggish  stream,  with  alluvial  banks,  which  empties  into  the 
river  at  the  foot  of  Third  Street,  taints  the  air  in  its  neighbourhood. 
The  ponds  send  up  their  effluvia  from  the  south ;  and  the  extended 
rocks  of  the  foils,  laid  bare  by  the  retreating  river  in  dry  seasons, 


256  PNEUMONIA    AND 

exhales  the  poison  of  intermittent  fever.  The  inhabitants  along 
the  Beargrass,  and  of  Water  Street,  and  of  the  scattered  dwellings 
in  the  outskirts  of  the  city,  are  sorely  afflicted  with  the  fever.  The 
infected  circle  is  receding.  In  1837,  it  was  not  deemed  safe  to  re 
side  nearer  the  limits  of  the  city  than  Walnut  Street.  Now,  Chest 
nut  Street  is  considered  healthy.  As  we  go  from  the  suburbs 
towards  the  crowded  parts,  the  chances  for  health  increase,  and,  as 
the  new  streets  are  built  up,  a  barrier  to  the  fever  poison  is  thrown 
around  the  older  neighbourhoods."1 

If  the  reader  desires  to  have  another  convincing  proof  of  the 
cessation  of  the  production  of  autumnal  fever  from  changes  of  the 
kind  mentioned,  let  him  come  and  see  what  has  been  the  result  in 
Philadelphia.  In  former  days,  when  the  city  was  of  limited  ex 
tent — with  few  improvements — with  buildings  scattered  about,  and 
leaving  open  and  unimproved  spaces  between  them — with  a  marshy 
stream  running  through  the  greater  part  of  it — with  ponds,  natural 
and  artificial,  spotted  over  the  plot  in  various  directions,  and  with 
unpaved  streets — fever  was  of  common  occurrence,  and  epidemics 
were  not  unfrequent.  At  present,  malarial  fevers  are  unknown  in 
the  city  proper,  as  well  as  in  the  compactly  built  and  well-drained 
portions  of  the  suburban  districts.  If  we  wish  to  meet  with  them, 
we  must  go  to  the  outskirts  of  these  districts,  or  to  some  distance 
from  them,  to  the  open  meadow  ground  of  the  neck,  or  to  other 
unimproved  surfaces  of  the  vicinity ;  but,  more  particularly,  to  the 
marshes  which  still  exist  along  the  river  banks. 

Our  townsman,  Dr.  Emerson,  who  has  devoted  considerable 
attention  to  the  subject  of  public  hygiene,  and  furnished  several 
excellent  essays  on  the  vital  statistics  of  Philadelphia,  has  conclu 
sively  shown  that  the  influence  of  the  sickly  air  is  expended  upon 
the  comparatively  limited  portion  of  the  population  living  in  the  en 
virons  and  outskirts  of  the  city.  During  the  periods  embraced  in  his 
calculations — and  the  same  holds  good  in  all  other  times  and  places 
—the  fever,  in  some  of  its  forms,  was  almost  universal ;  whilst,  in  the 
more  dense  and  well-paved  parts,  the  air  seemed  unusually  healthy; 
and  where  remittents  and  intermittents  were  met  with,  they  could 
almost  invariably  be  traced  to  exposure  to  night  air  in  the  country 
or  suburbs.  Never,  he  remarks,  was  a  stronger  demonstration 

1  Sanitary  Condition  of  Louisville;  Trans,  of  Mcd.  Assoc.  ii.  (ill.  Oil':  set-  also 
Drake,  249. 


AUTUMNAL   FEVERS.  257 

afforded  of  the  resistance  made  by  cities  to  the  influence  of  country 
malaria,  than  our  late  experience  has  furnished.  Great  as  was  the 
amount  of  sickness  during  the  epidemic  of  1822  and  3,  it  was  con 
fined  almost  entirely  to  the  comparatively  small  proportion  of 
population  inhabiting  the  unpaved  or  ill-paved  environs.  "Our 
.observation/'  Dr.  E.  adds,  "  on  this  and  other  occasions,  has  led  us 
to  ascribe  this  exemption,  for  the  most  part,  to  the  pavements, 
which,  by  effecting  a  perfect  drainage,  prevents  exhalation,  at  the 
same  time  that  it  admits  of  the  total  removal  of  vegetable  and 
animal  matters,  the  sources  of  foul  and  unhealthy  emanations. 
The  chief  motive  for  paving  the  streets  and  sidewalks  is  usually 
convenience ;  but  it  has  always  appeared  to  us  that  by  far  the 
most  important  object  achieved  by  it  was  the  preservation  of 
health."1  Since  the  time  to  which  this  has  reference,  thirty  years 
have  elapsed.  In  the  interval,  the  compact,  dense,  and  well-paved 
parts  have  extended  far  beyond  where  they  were  then,  and  with 
their  expansion  the  disease  has  receded. 

Hear  what  a  physician  of  the  middle  of  the  last  century  says : 
"  When  I  first  came  into  this  city,  the  dock  was  the  common-sewer 
of  filth,  and  was  such  a  nuisance  to  the  inhabitants  about  it,  that 
they  were  obliged  to  use  more  pounds  of  bark,  than  they  have 
ounces,  since  it  has  been  raised  and  levelled."2 

Hear  also  what  Dr.  Bond's  distinguished  contemporary,  Cadwal- 
lader  Golden,  states :  "  I  remember  that  several  years  since,  when  I 
was  at  Bristol,  Pa.,  opposite  to  Burlington,  which  is  situated  to  the 
northward  of  a  large  space  of  swamp  ground,  they  told  me  that 
they  had  been,  from  the  first  settling  of  Bristol,  subject  to  inter 
mittent  fevers  of  a  malignant  kind;  and,  indeed,  the  aspect  of  the 
inhabitants  showed  the  ill  effects  of  the  air  which  they  breathed. 
While  I  saw  them,  they  assured  me,  at  the  same  time,  that  not 

1  Amer.  J.  ix.  27. 

2  Bond's  Introductory  Lecture,  delivered  at  the  Pennsylv.  Hospital,  Dec.  17,  1776; 
N.  A.  Med.  and  Surg.  J.  iv.  270. 

During  the  winter  of  1849,  1850,  the  New  Orleans  city  authorities  ordered  all  the 
timber  standing  between  the  city  and  the  Metairie  ridge — an  elevated  space  between 
the  city  and  lake,  in  the  midst  of  a  cypress  swamp — to  be  cut  down.  The  greater 
part  of  the  ground  was  also  well  drained.  By  this  means,  an  extensive  swamp  was 
dried  up  by  the  rays  of  the  sun,  and  the  obstruction  to  free  ventilation,  by  the  breezes 
of  the  lake,  removed.  Writing  a  year  after,  Dr.  Fenner  says:  "I  think  it  not  at  all 
improbable,  that  this  work  has  already  exerted  a  beneficial  influence  upon  the  health 
of  the  city." — Southern  Medical  Reports,  ii.  83. 

17 


258  PNEUMONIA    AND 

above  two  or  three  children,  born  in  that  village  since  its  first  set 
tling,  had  attained  to  the  age  of  maturity;  but  since  that  time, 
these  swamps  having  been  drained  and  converted  into  profitable 
meadow  grounds,  I  am  informed  that  Bristol  is,  in  a  great  measure, 
freed  from  these  annual  epidemical  fevers."1  Speaking  of  Cahawba, 
Ala.,  Dr.  English  states  that  the  land  in  the  immediate  vicinity  of 
the  town  is  low  and  flat,  and  was,  until  1840,  interspersed  with 
numerous  small  shallow  ponds.  These  have  been  thoroughly 
drained,  and  now  hold  water  but  a  few  hours  after  the  heaviest 
rains.  It  has  become  a  subject  of  remark  by  the  citizens  of  the 
place,  that  since  that  time  the  town  has  become  much  more  healthy, 
particularly  as  regards  endemic  fevers.  In  truth,  in  the  last  four 
or  five  years,  the  former  dreaded  scourge,  bilious  remittent  fever, 
has  almost  disappeared,  and  the  few  cases  that  do  occur  are  of  a 
mild  type.2 

Beneficial  effects  obtained  from  tlte  draining  of  marshes  prove  the 
existence  and  morlijic  agency  of  malaria. — Large  portions  of  the  Tuscan 
and  Luccan  Marshes,  the  maremmes  of  Albagna,  of  Ombrone,  Gros- 
setto,  Orbatello  (between  Sienna  and  the  sea),  Campilla,  Piombino, 
Castiglione,  the  val  di  Chiana,3  have  been  reclaimed ;  the  soil  has 
been  improved,  and  applied  to  useful  purposes,  and  there  sickness 
has  disappeared.  The  reader  will  find,  in  Tozetti's  travels  in  Tus 
cany,4  an  interesting  account  of  the  important  changes  effected  by 
the  Grand  Dukes  Cosmo  I.  II.  and  III.,  and  Ferdinand  I.  and  II., 
with  a  view  to  reclaim  the  marshes,  and  destroy  the  insalubrity  of 
the  country  around  Pisa,  and  of  the  satisfactory  results  thereby 
obtained.  At  a  later  period,  under  the  direction  of  Gaetano  Geor- 
gini,  and  by  order  of  Dukes  Leopold  I.  and  II.,  the  principal  basins 
of  the  Tuscan  Maremmes  were  drained,  and  otherwise  improved,  and 
there,  as  was  expected,  fevers  have  disappeared,  and  the  population 
has  sensibly  increased.  The  town  of  Massa,  which,  for  years,  was 
noted  for  its  insalubrity,  was  completely  restored  to  a  healthful  con 
dition  by  the  draining  of  a  large  and  deep  marsh,  situate  on  the 
north-east  of  it.  By  means  of  a  canal,  constructed  through  one 

1  Med.  Regist.  i.  O'J'J.  2  N.  0.  J.  vi.  108. 

3  Fossombroni,  Memoires  historkjues  ct  hydrauliques  sur  le  val  dc  Ohinna,  1780  : 
T;irtini  memorie  .sul  beneficiamento  dolle  Maremme  To.'x-uim,  -13;  Carricre,  32o. 

*  Voyage  Mineralogique,  Philosophiqtie,  ct  Historique  en  Toscane,  par  le  Dr.  J.  T. 
Tozotti,  i.  W.rl. 


AUTUMNAL    FEVERS.  259 

side  of  the  liollow,  the  water  escaped,  the  marsh  was  drained,  and 
the  morbid  effect  was  arrested.  A  few  years  after,  the  canal,  which 
was  too  small,  being  choked  up,  the  surface  once  more  became 
marshy,  and  fevers  reappeared;  but,  in  1829,  the  same  canal  was 
cleansed  and  widened ;  the  soil  \vas  again  dried ;  fevers  once  more 
ceased  to  prevail,  and  the  city  has,  since  then,  remained  healthy.1 

As  regards  the  Luccan  Marshes  improvements  had  been  effected 
in  them  as  early  as  1741,  when  one  of  the  three  basins,  into  which 
they  are  divided — the  Massaciuccoli — the  most  unwholesome  of  all, 
was  drained.  The  success  was  so  complete  that  fever  entirely  ceased. 
In  1768,  9,  the  sea-water,  owing  to  a  derangement  in  the  locks, 
once  more  covered  the  reclaimed  land.  As  a  natural  consequence, 
marshes  were  reformed,  and,  with  these,  the  disease  reappeared. 
The  mortality  at  Viareggio,  and  the  adjacent  parishes,  which  the 
year  before  had  not  exceeded  one  in  forty  of  the  population, 
amounted  now  to  one  in  fifteen  (170  in  1830).  The  locks  were 
repaired,  and  health  was  re-established.  In  1784,  5,  a  like  accident 
in  the  locks  occurred,  and  the  same  results  followed — fever  returned. 
In  the  former  of  these  years,  out  of  a  population  of  1,898,  1,200 
were  attacked,  while  the  number  of  deaths  was  92,  or  1  in  20  of 
the  whole  amount  of  the  inhabitants.  In  1785,  103  died,  out  of  a 
population  of  1,834,  or  1  in  about  18.  Again,  the  locks  were  re 
paired,  the  sea  was  excluded,  the  marshes  were  dried  up,  and  health 
was  once  more  restored.  Other  portions  of  these  pestiferous 
localities  were  reclaimed  in  1812,  1819,  and  1821,  and  everywhere 
the  success  has  been  equally  satisfactory.2  Need  I  add  that,  with 
the  diminution  or  cessation  of  fever,  the  population  has  increased? 
At  Grosseto  alone,  from  1814  to  1843,  the  augmentation  has  been 
from  53,175  to  70,179.3  In  Yiareggio,  the  number  of  inhabitants 
in  1733  was  1,509 ;  in  1823  (90  years),  it  had  increased  to  9,408.4 

On  the  opposite  effect,  the  following  remarks  of  Lancisi  deserve 
attention : — 

"  And  we,  taught  by  the  calamities  of  the  noble  and  crowded 
cities  of  Italy,  which  have  been  desolated  by  the  marshes  alone, 
behold  with  our  o\vn  eves  the  mischiefs  occasioned  by  stagnating 
waters,  without  looking  abroad  for  the  reasons  or  inquiring  for  the 

1  Carrierc,  Lc  01' mat  ile  1' Italic,  o'24,  5  :  Salvagnoli,  Saggio  delle  Statistica  medica, 
ck'lle  Marcmme  Toseanc. 

2  dicrdini.  An.  Jo  Chemie,  &o.  xxix.  22-").  234;   Melier.  op.  cit.  086. 

3  See  Carrie  re,  ooo.  4  Giordiui,  oj>.  cit.  2o7. 


260  PNEUMONIA    AND 

evidence  of  other  persons.  Aquileia,  for  example,  formerly  in  a, 
most  flourishing  condition  from  the  number  of  its  inhabitants,  even 
so  much  as  to  merit  its  advancement,  first  to  a  metropolitan  and  then 
to  a  patriarchal  dignity,  scarcely  retains  at  this  day  the  remains  of 
houses,  or  any  traces  of  its  former  splendour ;  and  the  sole  cause  of 
its  overthrow  has  been  the  contamination  of  the  air  from  undrained 
waters.  The  city  of  Brundusium,  formerly  so  famous,  is  lament 
ably  mentioned  by  Antoninus  Galatheus,  in  words  which,  by  reason 
of  their  aptness,  we  quote  :  'Moreover,  cities  situated  in  a  healthy 
climate  have  been  destroyed.  Cities,  indeed,  like  men,  have  their 
vicissitudes.  But  the  neglect  of  its  inhabitants  has  been  the  ruin 
of  Brundusium ;  for  had  outlets  been  made  for  its  waters,  it  would 
never  have  acquired  such  an  unhappy  distinction.' " 

The  effects  of  covering  sickly  places  luith  water  lead  to  the  same  belief. 
—But  draining,  improving,  and  cultivating  the  surface  of  infected 
localities  are  not  the  only  modes  of  putting  a  stop  to,  or  greatly 
diminishing,  the  prevalence  of  fever,  and  thereby  proving  the  fact 
that  these  must  arise  from  a  cause  exhaled  from  the  soil.  We  have 
seen,  on  the  authority  of  Pringle,  that,  during  the  campaign  of 
1748,  in  Brabant,  the  country  bordering  on  the  lower  part  of  the 
Maas,  was  rendered  more  unhealthy,  upon  letting  off  part  of  the 
water  by  which  the  country  around  the  fortified  towns  had  been 
submerged.  It  may  now  be  proper  to  add,  from  the  same  author, 
that  the  "  States  of  Holland,  being  made  sensible  of  the  sickness 
which  raged  at  Breda,  and  in  the  neighbouring  villages,  gave  orders 
to  let  in  the  water  again,  and  to  keep  it  up  till  winter."2  Indeed, 
experience  taught  Pringle  that,  "  as  to  cantonments  in  marshy 
grounds,  if  the  troops  must  remain  there  in  the  dangerous  season, 
it  will  be  better  to  float  the  fields  entirely,  than  to  leave  them  half 
dry."3  The  same  process  was  resorted  to  some  years  ago,  with 
complete  success,  at  Paris,  Bordeaux,  and  other  parts  of  France, 
and  is  never  neglected  there,  when  marshy  surfaces  cannot  be 
otherwise  reclaimed.4  We  have  already  seen  the  means  adopted 
to  correct  the  blunders  of  the  revolutionary  government,  in  1793. 
Blanc  informs  us  that,  while  the  British  troops  were  suffering  from 

1  Lancisi,  op.  cit.  lib.  i.  cap.  iii.  8;  see  also  Dr.  Mitchell's  Tr.,  Med.  Ilepos.  xiii.  10. 

2  Pp.  01,  02.  3  Ibid.  98. 

4*Turent  du  Chatelet,  An.  d'Hyg.  xi.  310;  Fleuriau  de  Bellevue,  Comptes  Rendus 
de  1'Acad.  des  Sc.  xxv.  838,  9. 


AUTUMNAL    FEVERS.  261 

the  Walcheren  fever,  "  the  native  inhabitants  affirmed  they  were 
less  sickly  than  usual  at  the  same  time,  owing,  as  they  said,  to  the 
unusual  quantity  of  rain  that  had  fallen  during  the  two  or  three 
preceding  months."1 

Indeed,  the  beneficial  effects  obtained  from  the  flooding  of  marshes 
or  insalubrious  surfaces,  by  artificial  means,  by  freshets,  or  otherwise, 
have  been  noticed  from  time  immemorial,  as  well  in  foreign  coun 
tries,  as  in  our  own.2  The  practice  is  certainly  not  new,  and  may 
be  traced  to  an  early  period  in  the  annals  of  hygiene,  as  the  reader 
will  find  by  reverting  to  the  history  of  Empedocles,  who  delivered 
the  inhabitants  of  Salimonte  of  the  effluvia  exhaled  from  the 
marshy  banks  of  the  neighbouring  rivers,  by  causing  these  to  be 
flooded  by  means  of  the  pure  water  of  other  streams.  In  many 
of  the  islands  of  South  America,  on  the  coast  of  Mexico,  at  Ba- 
tavia,  in  Africa,  in  the  East  and  West  Indies,  in  Europe,  and  else 
where,  sickness,  as  we  have  seen,  prevails  at  the  commencement 
and  close  of  the  rainy  season,  and  ceases  completely,  or  in  great 
measure,  when  the  rivers  are  high,  and  the  marshes,  swamps,  as 
well  as  the  country  generally,  are  covered  over  with  water. 

More  than  a  century  ago,  Desportes  expressed  himself  in  favour 
of  the  opinion  that  yellow  fever  arises  often  from  the  foul  condition 
of  ships,  and  attributed  the  escape  of  a  vessel,  the  Jason,  of  seventy- 
four  guns,  in  1746,  at  St.  Domingo,  to  its  extremely  leaky  condition, 
by  which  the  sources  of  exhalations  in  the  hold  were  submerged.3 

The  common  saying  of  the  sailors,  that  a  leaky  ship  is  ever  a 
healthy  ship,  is  well  known;  and,  in  conformity  with  the  result  of 
experience  on  that  point,  the  submerging  or  sinking  of  infected 
vessels  has  not  unfrequently  been  resorted  to  as  a  means  of  puri 
fication. 

The  practice  is  noticed,  as  extremely  useful  under  peculiar  cir 
cumstances,  by  Lancisi,  who  was  too  clear  an  observer  not  to  have 
discovered  that  marshes  are  "  harmless,  when  plentifully  diluted  and 
cleansed  throughout  by  pure  and  fresh  supplies  of  water."  Lancisi 
reminds  us,  too,  of  a  fact  mentioned  centuries  ago,  by  Strabo,4  and 
which  has  been  already  briefly  alluded  to  :  "  Alexandria,  in  Egypt, 

1  Dissertations,  i.  210. 

2  Carriere,  loc.  cit.  526 ;   Ludlow,  N.  Y.  J.  ii.  84 ;  CalJwcll,  Essay  on  Malaria,  75  ; 
Villcrme,  An.  d'Hyg.  ii.  340. 

3  Histoire  des  Maladies  cle  St.  Domingue,  i.  162. 

4  Geographia,  lib.  xvii.  278. 


262  PNEUMONIA    AND 

stands  near  the  marshes ;  and  although  it  ought  to  experience, 
durin^  the  scorching  heat  of  summer,  a  close  and  suffocating  air, 

O  O  '  o  i 

yet,  by  the  seasonable  rise  of  the  Nile,  nothing  filthy  exists  whence 
vitiated  exhalations  can  arise,  especially  when  the  Etesian  winds 
begin  to  blow  from  the  north,  and  arrive  after  sweeping  a  wide 
tract  of  sea." 

The  surface  now  covered  by  the  city  of  Rome,  as  well  as  that  over 
which  was  spread  the  ancient  mistress  of  the  world,  and  the  adjacent 
campagna,  could  scarcely  fail  to  be,  to  a  certain  extent,  insalubrious 
in  olden  times ;  but,  from  all  we  can  collect  on  the  subject,  it  would 
appear  to  have  been  less  so  formerly  than  it  is  at  the  present  day. 
When  limited  to  a  few  hills,  the  Quirinal,  the  Palatine,  and  the 
Capitoline,  marshes  of  large  size — the  great  and  little  Yelabrum — 
existed  in  the  close  vicinity.  At  no  great  distance,  were  other 
marshes,  the  Capuan,  and  those  of  Tarentum.  Then  there  were 
the  Lakes  of  Castiglione  and  Giuturna,  besides  smaller  lakes  or 
pools  situate  all  about  the  Iloman  territory.  Most  of  those  locali 
ties,  though  now  uninhabitable,  were  then  populous,  and,  in  all 
probability,  owed  their  greater  salubrity  to  the  fact  that  the  larger 
number  of  those  receptacles  of  water,  which  were  then  complete!  v 
filled,  have  been  partially  drained  by  artificial  means,  or  filled  up 
by  the  gradual  increase  of  their  subaqueous  soil,  and  retains  be 
neath  the  surface  the  water  by  which  it  was  once  covered. 

The  following  fact,  already  adverted  to,  illustrates  more  than  one 
of  the  results  here  mentioned :  "It  has  been  remarked  by  persons 
who  live  in  the  vicinity  of  Morne  Fortune  (St.  Lucia),  that  when  the 
military,  who  inhabit  the  Morne,  suffer  severely  from  sickness,  the 
inhabitants  of  the  town  of  Castrie  (in  the  close  vicinity),  are  gene 
rally  in  good  health  ;  and,  on  the  contrary,  that  when  the  inhabit 
ants  of  the  town  are  sickly,  the  garrison  on  the  height  is  compara 
tively  healthy.  The  Morne  is  a  bog  in  wet  weather ;  Castrie  is 
then  an  inundated  swamp ;  in  continued  dry  weather,  the  Morne 
has  a  hard  and  firm  surface ;  Castrie  is  then  a  swamp  advancing  to 
exsiccation.  The  fact  is  obvious,  and  presents  itself  as  a  cause  of 
what  takes  place."1  All  these  facts,  as  also  the  stoppage  of  febrile 
epidemics  by  a  profuse  fall  of  rain,  are,  besides  many  referred  to 
under  another  head,  attested  by  the  most  reliable  authorities.2 

1  11.  Jackson,  Sketch,  ii.  358,  9. 

2  Bully,  309;  James  Johnson,  43,   320,   330;   McWilliams,   184;  Pritchctt,   108; 
Boyle,  3,  123  ;  Dazille,  10;   Desportes,  i.  52,  80,  87;   Firmin,  3.  17;   Gillespie,  137; 


AUTUMNAL   FEVERS.  263 

To  the  same  effect  may  be  cited  the  beneficial  results  obtained 
in  France  and  elsewhere,  by  the  filling  up  of  ditches  and  other 
excavations — remarkable  examples  of  which  are  on  record.1  I 
might  dwell  on  the  effects  produced  by  the  covering  of  the  marshy 
margins  of  river  shores  by  sand  inundations,  as  observed  on  the 
borders  of  the  Baltic,  in  Holland,  Italy,  France,  Africa,2  &c.,  and 
particularly  on  the  well-known  case  of  the  Goodwin  Sands,  in  which, 
while,  from  a  similar  cause,  the  usefulness  of  the  land  was  destroyed, 
the  salubrity  of  the  vicinity  was  firmly  established.  I  might  also 
point  out  those  instances,  in  which  the  infection  of  a  locality  has 
been  remedied,  by  covering  the  focus  of  exhalation  with  earth,  as 
was  done  to  Galiopolis,  in  179G.3 

H.  McLean,  25;  Rush,  iv.  154;  Ferguson,  Recol.  199;  Cliishohn,  i.  294;  Ferguson. 
Med.-Ch.  Tr.  viii.  180,  1  ;  Lempriere,  i.  20;  Rochoux,  11;  Caillot,  121;  Valentin, 
89 ;  Gouraud,  Go  ;  Arnold,  31 ;  Furlong,  Med.-Cli.  Rev.  xxv.  289  ;  Dickson,  Edinb. 
J.  xiii.  47  ;  Bancroft,  200;  Berthc,  150  ;  Macculloch,  204-0;  Brown,  in  Cyc.  of  Pract, 
Med.  iii.  01  ;  Cooke,  Med.  Rec.  vii.  457 ;  Pinckard,  ii.  485,  0 ;  U.  Parsons,  204;  Irvine, 
Dis.  of  Sicily,  6 ;  R.  Jackson,  Sketch,  ii.  259. 

1  Monfalcon,  43  ;  Macculloch.  120,  7;  Cycl.  of  Pract.  Med.  iii.  61. 

2  Macculloch,  207.  3  Potter  on  Contagion,  16. 


CHAPTER    IV. 

EXISTENCE   AN»   MORBID  AGENCY   OF   MALARIA, 
CONTINUED. 

The  effect  of  the  "washing"  of  sickly  places  lead  to  the  same  belief. — 
In  the  preceding  chapter,  attention  was  called  to  the  salutary  effects 
of  perfect  drainage,  as  illustrative  of  the  existence  and  morbid  agency 
of  a  malarial  poison.  With  the  same  view  I  may,  besides,  appeal  to 
those  instances  in  which  places,  heretofore  insalubrious,  have  been 
rendered  otherwise,  by  being  thoroughly  washed,  through  the  agency 
of  a  freshet,  or  an  inundation,  which  carried  off  all  substances  sus 
ceptible  of  decomposition,  and  left  in  their  stead  a  deposit  of  in 
nocuous  materials — as  occurred  in  New  Orleans,  after  the  crevasses 
of  May,  1816,  and  1849, l  and  more  recently  in  some  parts  of  the 
State  of  Pennsylvania.  In  the  latter  instance,  prior  to  September, 
1850,  intermittent  fever  prevailed  to  a  great  extent  along  the 
course  of  the  Schuylkill,  and  was  found,  in  many  instances,  to  be 
unmanageable,  showing  a  tendency  to  a  frequent  recurrence.  But, 
since  the  flood  which  took  place  at  the  time  mentioned,  the  same 
localities  have  been  remarkably  free  from  it.2  A  flood,  the  highest 
that  ever  occurred  in  the  same  river,  took  place  on  the  night  of 
the  2d  and  3d  of  September,  1850.  "  It  completely  inundated  a 
small  village,  of  about  thirty  houses,  in  our  neighbourhood,  besides 
some  farm-houses.  It  filled,  of  course,  all  the  cellars  and  wells,  and 
it  left  besides  a  great  deal  of  filthy  rubbish,  forming  a  deposit  of 
mud,  of  several  inches  in  thickness,  of  a  most  offensive  character. 
The  greater  part  of  two  weeks  must  have  elapsed  before  the  cellars 
could  be  cleansed,  and  the  wells  be  fit  for  use.  Meanwhile,  the 
people  were  living  in  filth,  and  without  the  usual  supply  of  pure 

1  Transactions  of  the  Pennsylvania  State  Medical  Society,  ii.  34 ;  see  also  i.  24. 

2  Nicol,  Obs.  on  the  Nature  of  the  Climate  of  Seringapatam,  Edinb.  J.  xi,  290  ;  J. 
Johnson  on  Trop.  Cl.  101. 


266  PNEUMONIA    AND 

water,  and  the  surface  of  the  ground  everywhere  about  them 
covered  with  the  mud  above  alluded  to.  Yet,  I  am  not  aware  that 
this  state  of  things  had  the  least  influence  in  aggravating  the  fevers 
then  prevailing.  I  asked  the  wife  of  a  farmer,  who  had  suffered 
as  much  from  the  flood  as  any  other  person,  and  in  whose  family 
intermittent  fever  prevailed,  what  effect  the  flood  had  had  upon  the 
disease.  Iler  answer  was:  "I  think  we  have  had  less  of  the  ague 
since  the  flood  than  before  it."1  In  this  case,  the  materials  of 
malaria  were  washed  away  in  some  parts,  and  new  innocuous  mud 
was  left  in  its  place. 

We  learn,  from  Yitruvius,  that,  in  the  lagunes  of  Yenice,  the  air 
was  extremely  pure,  especially  around  Ravenna,  Altino,  and  Aqui- 
leia,  the  three  principal,  and  doubtless  the  most  populous  points. 
He  himself  affords  us  the  explanation  of  this  anomaly.  At  that 
remote  period,  the  marshes  and  ponds  were  situate  to  the  north 
and  east  of  those  districts,  and  their  bottoms  were  higher  than  the 
level  of  the  sea  ;  owing  to  which  the  latter,  at  every  ebbing  of  the 
tide,  carried  away  all  the  putrescent  materials  and  filth,  and  thereby 
cleansed  the  lagunes. 

In  Seringapatam,  materials  of  putrefaction,  for  about  eight 
months  of  the  year,  lie  all  over  the  banks  of  water  streams  and 
other  repositories,  "until  the  periodical  rains  of  Malabar  begin, 
which,  falling  in  the  Ghauts,  run  down,  and  fill  the  Cauvery  River. 
The  filling  of  this  river  is  always  very  sudden,  and  it  comes  rushing 
along  with  great  impetuosity;  sweeps  out  all  the  filth  from  the 
ditches ;  clears  away  all  the  impurities,  so  long  stagnant  on  the 
island ;  and  leaves  the  place,  for  a  while,  tolerably  healthy,  and 
the  air  cool  and  refreshing."2 

The  city  of  Avignon  was  inundated  on  the  oOth  of  October, 
and  the  4th  of  November  by  a  rise  of  the  Rhone.  Nine-tenths  of 
the  city  were  under  water.  No  fever,  however,  followed,  owing  to 
the  complete  washing  which  the  surface  underwent,  and  the  super 
vention  of  the  cool  north  winds,  which  wafted  the  morbid  exhala 
tions  along  the  great  valley  of  the  Rhone  out  to  sea.3 

With  equal  propriety,  I  may  call  attention  to  the  results  obtained 
in  some  parts  of  the  Pontine  Marshes,  as  well  as  in  and  about  the 

1  Pennypacker,  of  Chester  County,  Tr.  of  Perm.  St.  Mod.  Soc.  i.  69. 

2  J.  Johnson  on  Trop.  Cl.  101 ;   Nicol,  Obs.  on  the  Climates,  £c.  of  Seringapatam, 
Edinb.  J.  xi.  290. 

3  Gouraud,  Ficvres  Interm.  Pernicieuses,  133,  4. 


AUTUMNAL   FEVERS.  267 

Eternal  City.1  In  former  days,  that  part  of  Home  on  which  the 
immense  population  was  crowded,  and  which  is  now  almost  deserted, 
was  healthy — comparatively  so,  at  least — while  the  insalubrious 
sections  were  the  Campus  Martins,  the  Velabrurn,  and  other  parts 
bordering  on  the  river ; — the  site  of  the  modern  city.  The  reverse 
is  now  the  case;  for,  as  we  approach  the  inhabited  parts  of  the  pre 
sent  city,  through  the  space  separating  St.  John,  of  Lateran,  from 
the  Forum  and  the  Yelabrum,  we  pass  over  the  principal  focus  of 
the  pestiferous  exhalations.  On  the  other  hand,  the  surface  of  the 
Campus  Martins,  or  indeed  the  whole  valley,  is  free  from  the  tainted 
atmosphere.  The  very  section  appropriated  to  the  Jews,  the  Guetto, 
where  the  principles  of  public  hygiene  are  sadly  neglected,  is,  to  a 
very  great  degree,  healthy.  How  has  this  happened?  The  Campus 
Martins  was  purified  by  Leo  X.,  and  the  surface,  after  being  divided 
into  streets,  was  soon  covered  with  houses,  churches,  and  other  build 
ings.  The  population,  at  the  close  of  the  reign  of  that  pontiff,  had 
already  reached  60,000.  The  narrow  valley,  between  the  Tiber  and 
the  Pincian  Hill,  by  which  we  now  enter  Kome,  was  transformed 
from  a  vast  marsh  into  the  beautiful  Piazza  del  Popolo ;  and  other 
portions  were,  by  successive  pontiffs,  greatly  ameliorated.2  The  site 
of  the  old  city,  which  was  not,  originally,  favourable  to  health — 
both  on  account  of  the  peculiar  condition  of  the  soil,  and  its  ex 
posure  to  the  influence  of  distant  sources  of  miasmal  infection,  but 
which  had  been  rendered  much  less  hurtful  by  drains,  the  erection 
of  numerous  aqueducts,  and  other  works  of  kindred  character — has 
returned  to  its  pristine  state.  It  has  gone  to  destruction,  and  is 
now  deserted.  The  houses  and  monuments  by  which  it  was 
covered  have  disappeared ;  the  greater  number  of  the  aqueducts 
have  been  destroyed,  with  the  effect  of  allowing  the  free  escape  of 
the  water,  and  the  formation  of  marshes  and  pools ;  the  drains  have 
been  choked  up,  and  the  whole  surface  presents  a  mass  of  ruins  and 
rubbish.3 

Much  more  might  be  said  on  this  important  subject ;  but  the 
instances  mentioned  must  suffice.  They  furnish  us  with  both 
proof  and  counter- proof.  With  the  existence  of  marshes,  or 
marshy  and  partially  drained  land,  we  have  fever;  with  the  re- 

1  See  Carriere,  Climat  de  1'Italie ;  and  Tournon,  Etudes  sur  Rome. 

2  Carriere,  op.  cit.  101. 

3  See   Review  of  Carriere,  by  the   present  -writer,   Am.  Journ.   of  Mod.  Sci.  July, 
1851,  p.  103. 


268  PNEUMONIA    AND 

claiming  of  that  land,  or  its  complete  overflow,  fever  disappears. 
Whenever,  as  in  some  cases  cited,  the  surface  returns  to  its  pristine 
marshy  condition,  the  unhealthiness  of  the  country  returns  also. 
Once  more  the  marshes  are  drained,  and,  with  the  improvement  of 
the  land,  we  have  a  cessation  of  fever.  In  some  instances,  the  disease 
is  found  to  break  out  in  impure  city  localities ;  the  effect  is  remedied 
by  a  judicious  employment  of  drains,  sewers,  and  other  kindred 
means.  Nothing,  it  appears  to  me,  can  be  more  satisfactory ;  be 
cause  no  one  who  has  looked  at  all  into  this  matter,  can  have 
failed  to  perceive  that,,  of  all  diseases  which  are  susceptible  of 
assuming  an  epidemic  character,  few  or  none  exhibit  so  clearly 
the  close  relationship  between  the  existence  of  certain  local  agents 
and  the  effects  produced  by  them,  as  periodic  fevers ;  none  the 
productive  causes  of  which  are  more  strikingly  and  undeniably 
under  the  control  of  human  agency.  And  when,  bearing  these  cir 
cumstances  in  mind,  we  revert  to  the  fact  that  the  mixture  of  salt 
and  fresh  water  has  been  found  to  increase1  greatly  the  unhealthi 
ness  of  marshy  surfaces — a  result  foreseen  by  Yitruvius,2  pointed 
out  more  satisfactorily  by  Lancisi,3  dwelled  upon  by  Gul.  Piso,4  Sir 
J.  Pringle,5  and  Sylvius;6  noticed  more  than  a  century  ago  in  this 
country  by  Cadwallader  Golden,7  and  subsequently  by  Ludlow,8 
and  other  American  writers;  and  confirmed,  beyond  dispute,  by  the 
effects  observed  at  Bender- Abassi,  on  the  banks  of  the  Persian 
Gulf  ;9  at  the  Valduc  ;10  at  Martigues ;  in  the  Luccan  Marshes,  near 
Yiareggio,  Motrone,  and  Montignoso;  at  Sebgha  (Algeria);  in  South 
America,  &C.;11  it  will  be  difficult  to  resist  the  conclusion  that  some 

1  "  There  dreadful  is  the  air  in  low  places,  near  the  sea-shore,  into  which  the  waves 
find  entrance  by  a  canal  that  has  either  been  open  during  the  memory  of  man,  or  made 
by  human  artifice,  or  produced  by  a  storm  ;   and  into  which  receptacle  also   the  rains 
wash  down  the  filth  from  the  adjoining  knolls  and  hills."     "  There  are  some  ponds  of 
the  kind  in  the  territories  of  Ferrara  and  Ravenna  as  well  as  of  Home,  especially  near 
Ostea,  where  the  salt-works  have  been  erected." — Lancisi,  op   cit.  18. 

2  De  Architectura,  lib.  i.  cap.  iv.  3  De  Nox,  Paludc  Effluviis,  10,  18. 

4  Hist.  Nat,  and  Med.  lib.  i.  0.  5  Diseases  of  the  Army,  Appendix,  370. 

6  Tract.  Med.  Append.  Tract,  x.  101. 

7  Account  of  the  Fever  of  New  York  in  1741,  42.   Med.  and  Philos.  Register,  i.  323. 

8  New  York  Med.  and  Phys.  Journ.  ii.  85. 

9  Chardin,  Voyage  en  Perse;   Fodere,  Med.  Leg.  v.  10'.). 

10  Fodere,  ib.  108. 

"  Giordini  (Gnetario),  Causes  dc  1'Insalubrite  de  1'Air  dans  le  voisinage  des  niarais 
en  communication  avec  la  mer.  Ann.  de  Chimic.  xxix.  220  ;  Carrie-re,  Climat  de 
ritalu-.  271';  Bou.ssiiigault,  Ann.  de  Chiuiic.  Ivii.  150,  151  ;  Salva  (in  Roehunx).  120; 


AUTUMNAL    FEVERS.  269 

poison  exhales  from  surfaces  where  the  mixture  occurs,  and  that 
the  disease  which  ensues  or  prevails  more  widely  there  is  the  effect 
of  it,  and  not  simply  of  heat,  moisture,  atmospheric  vicissitudes, 
or  other  agencies  of  the  kind. 

The  conclusion  will  appear  the  more  natural  when  we  learn  that, 
while  such  is  the  effect  of  the  mixture  in  question,  it  has  been 
found  that,  in  the  salinas  of  France,  fevers  are  limited  to  the  edges 
and  immediate  vicinities  of  the  rivulets,  ditches,  and  canals  sur 
rounding  or  running  through  the  salt  basins,  but  containing  fresh 
water ;  and  do  not  affect  the  extensive  surfaces  on  which  unadulter 
ated  sea-water  is  introduced  for  the  purpose  of  evaporation,  and 
which,  at  a  certain  period  of  the  process,  assume  the  outward  cha 
racters  of  ordinary  marshes;1  when,  besides,  we  find  that,  so  far 
from  these  pure  salt  marshes  proving  injurious,  the  physicians  of 
Marseilles  (Mercandier,  Eobert,  Peyron,  Girard,  &c.),  to  \Yhom  the 
subject  was  referred  for  examination,  have  pointed  out,  and  expe 
rience  has  demonstrated,  the  benefit  resulting  from  the  conversion 
of  common  paludal  localities  into  regular  salinas,  as  may  be  found 
by  referring  to  the  oft-quoted  Eeport  of  Melier,  contained  in  the 
loth  vol.  of  the  Memoire  of  the  Academy  of  Medicine  of  Paris,  p.  655 ; 
and  that,  conversely,  the  change  of  a  salina  into  a  common  marsh, 
has  been  folio \ved  by  the  appearance  and  wide  prevalence  of  fever, 
which  heretofore  had  not  existed — a  change  which  has  caused  the 
almost  total  depopulation  and  destruction  of  the  once  flourishing 
cities  of  Marenne  and  Brouage,  in  France.2  Dr.  Ludlow,  of  New 
York,  remarks  that  the  results  of  his  observations,  made  at  the 
villages  of  Salina  and  Montezuma,  New  York,  where  this  combi 
nation  takes  place  is,  that  it  depends  entirely  on  the  proportions  in 
which  the  waters  are  mixed.  If  the  waters  of  fresh  marshes  are 
largely  combined  with  salt  water,  or  vice  versa,  the  general  healthi 
ness  of  the  situation  will  be  improved.  Dr.  Hosack  mentions,  in 
his  lectures,  that  the  marshes  of  Hoboken,  in  New  Jersey,  while 
overflowed  by  the  sea-water,  were  healthy,  intermittent  and  remit- 

Trail,  Outlines  of  Medical  Jurisprudence;  Me  Williams,  100;  Daniel,  Med.  Gaz. ;  Me 
lier.  Mem.  do  1'Acad.  xiii.  684 ;  Monfalcon,  09,  70 ;  Thouvenelle,  Climat  de  1'Italie, 
i.  180,  183;  iv.  34,  83,  218;  Sigaud,  du  Climat  et  des  Maladies  du  Bresil,  172;  Mori- 
cliini,  32. 

1  Melier,  op.  cit,  035,  636,  684;  Jacquot,  loc.  cit.  21,  25,  47  ;   Maillot;  Bourdier,  in 
same  ;  Maccullocli,  37,  8. 

2  Melier,  op.  cit.  642,  645;  ib.  651,  665. 


270  PNEUMOXIA    AXD 

tent  fevers  being  unknown ;  but  since  they  have  been  drained,  and 
the  ingress  of  the  salt-water  has  been  prevented,  these  diseases  are 
endemic.  This  was  farther  proved  by  the  breaking  of  the  dykes 
during  their  prevalence,  when  they  immediately  ceased.1  When, 
again,  we  bear  in  mind  that  the  morbific  effects  produced  in  the 
localities  mentioned  are,  sometimes  at  least,  circumscribed,  like 
those  noticed  on  shipboard,  within  very  narrow  bounds ;  that  while 
in  vessels  the  area  of  the  infection,  which  necessarily  can  never 
be  large,  is  as  already  stated  often  limited  to  one  side  or  one  end 
of  the  under-decks,  or  to  the  vicinity  of  the  pumps,  where,  indeed, 
it  usually  commences,  the  disease  on  land  is  frequently  confined  to 
the  immediate  neighbourhood  of  a  pond,  of  a  mill-dam,  of  a  slug 
gish  stream,  of  masses  of  decaying  or  green  timber,  or  of  other 
vegetable  or  animal  substances,  separate  or  combined,  in  a  state  of 
decomposition,  or  of  a  drain,  or  cesspool2 — not  seldom  to  one  side 
only  of  these ;  to  an  overflowed  field  or  bank ;  to  a  few  streets  of  a 
city,  to  one  single  street,  or  even  to  one  side  of  this  ;3  to  a  few  build 
ings;  to  one  solitary  house,  or  side  of  a  house,  or  room,  or  corner 
of  a  room,4  or  the  like ;  we  cannot  well  see  how  all  these  facts — 
the  reality  of  which  will  not  be  contested — can  be  explained  on 
the  principles  set  forth  by  the  opponents  of  malaria.  The  degree 
of  heat  and  humidity,  the  extent  of  the  dew-point,  the  amount  of 
atmospheric  vicissitudes  and  other  morbid  influences  to  which  they 
look  for  the  causes  of  the  disease,  can  scarcely  be  supposed  to  be 
so  much  greater  on  one  side  of  a  street,  in  a  few  buildings,  in  a 
solitary  house,  in  one  room,  or  corner  of  a  room,  than  on  the  other 

1  Op.  cil.  ii.  85;   Hosack's  Practice,  175. 

2  Hush,  iv.  90;  Potter,  16;  Caldwell,  Dissert.  491,  2;   ib.  Essay,  09,;    ib.  Fever  of 
1805,  p.  00  ;  Picornel,  in  Thomas,  8,  22;  Usher  Parsons,  Essays,  215  :  ib.  Hays's  Journ. 
vii.  80;  ib.  Boston  Med.  Journ.  iii.  074,  088;  Hand,  Med.  Reposit.  ii.  407;   Valentin, 
Voy.  Med.  55,  0;  Vicq  d'Azyr,  on  City  Interments ;  see  Review  of  this  work  in  Chap 
man's  Journ.  vii.  200-8;  Audouard,  Archives,  xii.  312;   Tr.  of  Med.  Soc.  of  State  of 
Pennsyl.  ii.  51 ;  Harris,  Charleston  Med.  Journ.  ii.  015  ;  Second  Report  on  Quarantine 
(Lond.  1852),  07,  08  ;   Gaultier  de  Claubry,  Mem.  de  1'Acad.  de  Med.  xiv.  118. 

3  Lancisi,  op.  cil.  154;   Bancroft,  105;  Berthe,  74;   Baglivi,  158;    lligault  do  ITsle 
(in  Johnson),  315;  Amer.  Rev.  iv.  290;   Faust,  Amer.  Journ.  vi.  53;   Trans,  of  Med. 
Soc.   of  State  of  Pennsyl.   ii.   93;    Macculloch  ;    Lefouion,    p.    00.    note;    Pendleton, 
Charleston  Journ.  vii.  450;   Becquerol,  sur  les  Climats,  10. 

4  Lancisi,  154;   Ferguson,  Med.-Chirurg.  Trans,  viii.  14:!;   Callow  in  Cycl.  ii.  2SO  : 
Wilson.  158,  9  ;     Vutable,  314 ;     Rufz.  28  ;     Imray,  Ivlinb.    Jouni.    Ixiv.    355 ;     Davy, 
To[.og.    of  Medit.    ii.  248;     Harris,  Charleston  Journ.  ii.  015:     !><-<.iih,  Life    of   Arm 
strong,  ii.  721;    Second  Report  on  Quarantine.  21.  22.  183. 


AUTUMNAL    FEVERS.  271 

side  of  the  same  street,  in  adjoining  houses,  in  other  rooms  of  the 
same  building,  or  other  corners  of  the  sickly  room,  to  account  for 
the  difference  of  results.  Everything  in  this  bespeaks  the  exist 
ence  of  a  separate  morbific  agent,  penetrating,  in  combination  with 
the  atmospheric  air  to,  or  generated  in  the  infected  spof,  and  sparing, 
owing  to  reasons  I  need  not  stop  to  explain,  neighbouring  or  adjoin 
ing  localities. 

Some  forms  of  malarial  fevers  resemble  diseases  produced  by  putrid 
substances  introduced  into  the  circulation. — The  incorrectness  of  the 
views  of  those  who  refuse  to  acknowledge  the  existence  and  agency 
of  a  malarial  poison,  will  the  more  forcibly  strike  us,  when,  reverting 
to  the  preceding  circumstances,  we  bear  in  mind  the  great  analogy 
existing  between  the  phenomena  of  some  forms  of  fevers  and  those 
produced  by  the  introduction  of  putrid  substances  in  the  torrent  of 
the  circulation,  or  the  forced  inhalation  of  mephitic  air,  as  shown 
by  the  well-known  and  oft-mentioned  experiments  of  Gaspard, 
Magendie,1  Leuret,  Hamont,2  and  others ;  by  the  ingestion  of  va 
rious  mineral  and  vegetable,  and  the  absorption  of  some  animal, 
poisons3 — to  say  nothing  of  the  discovery  by  Lassaigne,  in  his 
analysis  of  putrid  meat  water,  of  a  stinking  volatile  oil,  the  probable 
poisonous  agent  in  the  effects  obtained  by  those  experimentalists, 
and  which  can  differ  but  little  from  the  substance  dissolved  in  the 
air  of  malarious  localities. 

Take  yellow  fever  as  an  example.  The  late  Dr.  Harrison,  of 
JSTew  Orleans,  who  was  perfectly  competent  to  form  a  correct  opinion 
on  the  subject,  speaking  of  the  effects  obtained  from  injecting  pu 
trid  meat  water  into  the  veins  of  animals,  as  shown  in  the  experi 
ments  of  Gaspard,  already  alluded  to,  says :  "  Ko  one  can,  I  think, 
fail  to  be  struck  with  the  extraordinary  resemblance  of  those  symp 
toms  and  post-mortem  lesions  to  those  of  yellow  fever.  The  charac 
teristics  of  the  disease,  its  rapid  course,  its  hemorrhagic  tendency, 

1  Journal  dc  Physiologic,  ii.  1,  and  iii.  81-85. 

2  Journal  des  Progres  des  Sc.  Med.  vi.  181. 

3  Fontana,    Traite    de  \\\  Vipere,    i.   85;     Celle,  Hygiene    des  Pays  Ckauds,   80; 
iSauvages,  Nosologie,  iii.   112,  115;  E.   Miller,  Works,  52,  53;   Med.  Repos.  ii.   412; 
Waring,  Yel.  Fey.  of  Savannah,  87,  38 ;    John    K.  Mitchell,  Cryptogamic    Origin  of 
Fever,  78;   Hunter,  Dis.  of  the  Army  in  Jamaica,  150;   Dcwitt  on  Stramonium,  Med. 
Reposit.  ii.   30:    Ferguson,  Recollections,  204,  5;    Caillot,  Fievre  J.  29(5;  Lcvacher, 
78;  Chaussicr,  Consultations  de  Mod.  Legale,  40;  Rochoux,  79 ;   Salva,  Sogundo  ano 
del  Real  Estudio,  &e.  142;  Lafuente,  Obeervaciones  Sobre  la  Fiebre  ainarilla,  201. 


272  PNEUMONIA    AND 

its  peculiar  lesions,  are  all  to  be  met  with  in  these  experiments.  We 
have  black  vomit,  bloody  alvine  discharges,  redness  of  conjunctiva, 
extreme  tenderness  over  the  abdomen,  great  and  rapid  prostration 
of  strength,  burning  thirst,  anorexia,  &c. — all  so  characteristic  of 
yellow  fever.  In  his  other  experiments,  he  speaks  of  other  charac 
teristic  symptoms — suppression  of  urine,  intussusception  of  the 
intestines,  the  existence  of  fetid  fuliginous  matter  in  the  bowels, 
ecchymosis  of  the  mucous  membranes,  congestion  of  the  lungs,  &c. 
In  short,  there  is  hardly  any  symptom  mentioned  by  authors,  as 
occurring  in  yellow  fever,  which  may  not  be  found  in  these  experi 
ments  ;  and  it  is  the  same  with  regard  to  the  post-mortem  lesions."1 
Let  it  not  be  supposed  that  other  substances,  when  injected  into  the 
veins,  will  produce  similar  effects.  Graspard,  and  after  him  Magen- 
die,  have  found  that  many  of  them  cause  death,  but  none  give  rise 
to  the  symptoms  or  anatomical  lesions  described  above.  Those  pro 
duced  by  ammonia  come  nearest  to  them. 

Let  us  also  bear  in  mind  that  dead  animal  matter  is  found  to 
run  faster  into  putrefaction,  in  situations  where,  from  the  prevalence 
of  fever,  marshy  exhalations  may  be  supposed  to  abound ;  that 
beer,  wine,  and  other  fermentable  fluids,  if  kept  there  on  the 
ground,  spoil  sooner  than  in  healthy  localities;2  that  the  active 
operation  of  such  exhalations  on  sores  and  wounds  is  often  evinced 
during  life;  that  substances  fabricated  of  silk,  wool,  cotton,  and 
flax,  very  rapidly  undergo  decay  when  exposed  to.  the  atmosphere 
of  such  situations — silk  and  woollen  becoming  putrid,  and  cotton 
and  linen  assuming  a  dingy  or  yellow  hue,  and  afterwards  losing 
their  cohesion ;  and  that  these  effects,  which  in  Italy,  France,  and 
other  countries  are  generally  recognized  as  indicative  of  the  insalu 
brity  of  particular  places  and  seasons,  though  rapid  and  complete 
in  proportion  to  the  moisture  and  warmth  of  the  air,  exhibit  them 
selves  to  the  fullest  extent  when  these  conditions  are  combined 
with  sources  of  concentrated  malarial  exhalations. 

When,  besides,  we  recollect  that  the  absorption  of  softened  tu 
bercular  matter,  in  small  proportion,  and  in  the  early  stage  of  its 
formation,  produces  an  intermittent  form  of  fever,  of  quotidian 
type,  and  recurring  in  the  evening;  that,  with  the  progress  of  the 
softening  of  this  matter  and  of  its  absorption,  the  type  of  the  fever 

1  Speculations  on  the  Cause  of  the  Yellow  Fever,  N.  0.  J.  iii.  570. 

2  Barton,  on  Hong-Kong  Fever,  Dublin  J.  (N.  S.)  xii.  345. 


AUTUMNAL    FEVERS.  273 

changes,  becoming  first  remittent,  and,  finally,  continued;  when  we 
recollect  that  the  fever  attendant  on  the  absorption  of  pus  formed 
in  the  parenchyma  of  the  liver  often  assumes  the  tertian  type,  and 
that  intermittent  febrile  paroxyms  of  great  regularity  have  resulted 
from  such  absorption  j1  when,  finally,  we  bear  in  mind  the  changes 
which  take  place  in  the  system  of  those  who  recover  from  yellow 
or  other  malarial  fevers,  through  the  unaided  efforts  of  nature  ;  the 
coincidence  of  the  sudden  and  successive  disappearance  of  the 
symptoms  with  the  appearance  of  phenomena  of  a  critical  character 
— dark  discharges  from  the  bowels,  abundant  sweats,  and  a  copious 
flow  of  flocculent  and  sediinentous  urine — so  like  what  is  known  to 
attend  the  expulsion  or  elimination  of  some  poisonous  substance, 
it  is  impossible  to  avoid  the  conclusion  that  fevers,  when  they  make 
their  appearance  in  the  localities  mentioned,  are  the  offspring,  not  of 
a  cause  of  a  general  character  or  of  physical  influences,  consisting  of 
some  particular  modification  in  the  ordinary  and  sensible  qualities 
— therinometrical,  hygrometrical,  electrical,  &c.,  of  the  atmosphere; 
since  these  operate  in  equal  degree  all  around,  without,  however, 
producing  every  where  the  morbific  effects  in  question;  but  of  some 
thing  exhaled  from  the  soil,  or  from  some  of  the  various  sources  of 
decomposition  adverted  to.  In  other  words,  we  must  infer  that 
fevers  arise  from  the  impress  of  a  species  of  morbid  material  poison, 
which  finds  admission  in  the  blood,  and  occasions  peculiar  changes 
iu  certain  of  the  constituents  of  that  fluid — conferring  subsequent 
immunity  in  many  cases,  like  other  causes  of  a  kindred  nature, 
though  in  a  less  degree,  and  with  less  certainty ;  possessing,  to 
some  extent,  other  characteristic  properties  of  true  morbid  poisons, 
but  differing  from  them  in  not  being  the  product  of  operations 
taking  place  in  the  living  system;  in  its  not  being  possessed  of  the 
power  of  reproducing  or  multiplying  itself  in  the  body ;  in  its  not 
converting  any  of  the  elements  of  the  blood  into  its  own  similitude, 
and  in  its  effect  not  being  capable  of  propagation  from  one  person 
to  another.2 

The  geological  formation  of  sickly  localities,  and  the  plants  growing 
therein,  etc.,  lead  to  a  belief  in  the  malarial  doctrine. — The  conclusion 
will  appear  still  more  natural,  when  we  take  the  following  facts 

1  P.oudin,  128,  120  ;   Griffin,  Lond.  Med.  Gaz. 

2  See  Simon's  Lect.  on  General  Pathology,  198,  Am.  ed. 

18 


274  PNEUMONIA    AND 

into  consideration :  Malaria  is  more  rife  in  localities  characterized 
by  particular  geological  formations.  In  both  the  West  and  East 
Indies,  places  where  the  mangrove  and  mancilina  grow  luxuriantly, 
the  most  unhealthy  are  those  in  which  the  roots  of  those  plants  are 
only  occasionally  under  water.  In  general,  in  tropical  latitudes, 
the  existence  of  a  large  quantity  of  astringent  plants — the  bark  of 
which  contains  a  large  portion  of  animal  matter,  combined  with 
tannin — is  connected  with  the  development  of  fever.1  Mr.  Boudin 
informs  us,  in  his  Treatise  on  Periodic  Fever,  that,  from  some  experi 
ments  made  by  himself,  he  is  inclined  to  the  opinion  that  certain 
plants,  more  than  others,  have  the  power  of  giving  rise,  by  their 
decomposition,  to  the  evolvement  of  febrific  exhalations.  Such  are 
some  of  the  algce,  as,  for  example,  the  chara  vulgaris.  lie  attributes 
the  same  febrific  faculty  to  the  rizophore  and  the  calamus  (p.  59).  In 
some  parts  of  France  (the  Department  of  Ain- — see  the  statistics  of 
that  Department,  p.  206),  a  similar  agency  is  attributed  to  the  An- 
thoxentum  odoratum. 

Cause  more  effective  near  the  surface  of  the^arth  than  at  a  distance. — 
The  cause,  though  sometimes  wafted  to  elevated  spots,  generally 
manifests  a  tendency  to  remain  near  the  surface  of  the  soil,  attacking 
more  generally,  and  with  greater  malignancy,  individuals  occupying 
the  lower  floors  of  houses.2  In  Italy,  and  alono*  the  shores  of  the 

J  I  O 

Mediterranean,  as  well  as  in  the  West  Indies,  the  ground  floors  are 
never  occupied  by  those  who  can  avoid  them  ;  and,  in  some  parts 
of  the  latter  country,  the  houses  are  built  upon  pillars,  by  way  of 
avoiding  the  poison.  When  the  Corsican  peasants  are  obliged,  in 
the  autumn,  to  leave  their  hill-towns,  for  the  purpose  of  working 
in  the  fields  below,  they  never  fail,  if  possible,  to  return  home  in 
the  evening.  When,  however,  the  distance  is  too  great,  they  con 
struct  temporary  cabins  on  the  tops  of  the  trees,  to  which  they 
carefully  ascend  for  the  night.3 

Much  of  this  may  arise  from  the  refrigeration  produced  by  up 
ward  radiation  of  heat,  which,  as  is  well  known,  exercises  a  marked 

1  Humboldt,  7r3-771;  &.  Personal  Nar.  iii.  191,  872. 

2  Smith,  Fev.  ot'  Gibraltar,  Edinb.  J.  xxxv.  35;  J.  Hunter,  300;   Cycl.  Trnct.  Mcd. 
ii.  280;    lUlpli.  Trans,  of  Edinb.  Med.-Chir.   Soc.  ii.   57,  59;    ib.  Eop.  in    Ferjruson, 
Med.-Chir.  Tr.  viii.  170;  Bancroft,  Scq.  448;  Blair  (notes),  30;  Cakhvell  on  Malaria, 
130;   S«\-  >\(\  Hep.  on  Quar.  60. 

3  Jacq.u.c,  9. 


AUTUMNAL    FEVERS.  275 

influence  as  an  exciting  cause  of  disease.1  But  this  radiation,  how 
ever  powerful  in  the  latter  capacity,  and  however  likely  to  arouse 
into  action  the  dormant  efficient  cause,  cannot  of  itself  give  rise 
to  any  of  the  various  forms  of  autumnal  fevers,  seeing  that  it  exer 
cises  the  influence  under  consideration  only  in  localities  the  infec 
tious  character  of  which  is  well  ascertained,  and  where  febrile 
attacks  take  place  without  its  agency.  Add  to  this  that  diseases 
justly  referable  to  its  sole  agency  belong  to  a  different  class. 

Cause  of  fevers  destroyed  or  mitigated  by  sanative  measures. — The 
morbid  effect  of  the  cause  is  destroyed  or  mitigated,  and  its  action 
neutralized  by  disinfectants  and  antiseptics,  which  operate  in  the 
same  way  on  contagious  poisons,  and  arrest  the  process  of  decompo 
sition  in  animal  and  vegetable  substances.  The  beneficial  effects  of 
these  agents,  in  all  the  cases  in  question,  indicate  a  similarity  of 
nature  in  the  morbid  causes  upon  which  they  exercise  their  neutral 
izing  and  destroying  influence.  Cold,  a  most  powerful  disinfectant 
and  antiseptic,  which  prevents  decomposition  for  an  indefinite,  if  not 
infinite,  period,  arrests,  as  we  have  seen,  the  prevalence  of  fever. 
Of  the  disinfecting  or  deodorizing  power  of  fire  or  heat,  much  has 
been  said  by  philosophers  and  physicians  in  olden  times ;  indeed,  if 
the  claims  of  any  hygienic  means  to  our  respect  could  be  enhanced 
by  its  antiquity,  few  would  be  more  entitled  to  it  than  the  one  in 
question.  It  was  recorded  long  before  the  days  of  Pliny,  who 
speaks  of  it  as  of  a  thing  well  known :  "  There  exists  in  the  very 
fires  a  remedial  power  against  pestilence  occasioned  by  obscuration 
of  the  sun  by  clouds,  and  by  an  excess  of  moisture.  Fire,  by  its 
fumigation,  certainly  assists  in  many  ways.  Empedocles  and  Hip 
pocrates  have  demonstrated  this  amply."2  Poets,  too,  recognized 
the  benefits  derived  from  that  agency.  "  Or  all  noxious  principles," 
Virgil  says,  "  may  be  dried  out  of  them  by  fire,  and  useless  moist 
ure  driven  out : — 

« Sive  illis  omne  per  ignent, 
Excoquitur  vitium,  atque  excedat  inutilis  humor.'  " 

The  reader  will  doubtless  recollect  that  it  is  reported  of  the  father 
of  medicine,  that  he  changed  the  morbific  state  of  the  atmosphere 

1  See  on  this  subject  an  excellent  Report  in  the  6th  vol.  of  Trans,  of  Am.  Med. 
Assoc. 

2  Cap.  27,  lib.  36. 


276  PNEUMONIA    AND 

at  Athens,  during  the  plague  described  by  Thucydides,  by  kindling 
large  fires.1  The  same  is  related  of  Acron  of  Agrigentum.2  At  a 
less  remote  period,  the  city  of  Rome  furnishes  a  striking  example 
of  the  benefit  which  was  supposed  to  arise  from  the  same  practice. 
"Rome,"  as  Lancisi  remarks,  "an  unwholesome  region  may,  thanks 
to  her  furnaces,  be  inhabited  with  safety."  Monfalcon  informs  us 
that,  when  the  French  troops  occupied  the  Mantuan,  during  the 
early  Italian  campaigns  of  Bonaparte,  they  were  forced  to  encamp 
on  the  marshy  surfaces  which  abound  in  that  province,  and  in  con 
sequence  exposed  to  malarial  fevers.  Bonaparte  succeeded  in  pre 
serving  the  health  of  his  men,  by  ordering  them  to  keep,  day  and 
night,  near  large  fires,  kindled  for  that  purpose.3 

Sir  Gilbert  Blane  speaks  in  the  highest  terms  of  heat  as  a  puri 
fying  agent  on  board  of  ships,  and  states  that  nothing  served  to 
contribute  so  much  to  disinfect  the  filthy  French  ships  captured  by 
Admiral  Rodney  in  the  famous  battle  of  1782,  and  sweeten  the  air 
in  them,  as  burning  fires  in  the  hold.4  And  we  all  know  the  ad 
vantage  resulting,  in  all  malarious  localities,  from  warming  and 
drying  the  houses,  especially  early  in  the  morning,  and  at  the 
approach  of  night. 

Chlorine,  and  other  fumigations,  destroy  ammonia  and  organic 
bodies  with  more  or  less  facility ;  and  there  are  not  wanting  facts 
to  show  that  they  exercise  a  salutary  influence  in  mitigating  or 
arresting  the  progress  of  fever.5  The  same  may  be  said  of  chloride 
of  lime,  whose  efficacy,  though  doubted  by  some  observers,6  is 
highly  thought  of  by  reliable  professional  authorities  in  this  and 
other  countries;7  of  chloride  of  zinc,  which  is  highly  extolled  by 
competent  judges;8  of  smoke,  which  has  been  successfully  employed 

1  Galen,  Thcrap.  ad  Pison ;  Aetius,  v.  94. 

2  Plutarch,  De  Iside  et  Osiridc,  see  Adams's  Trans,  of  Paulus  JEgineta,  i.  274  ; 
ib.    Tr.  of  Hippocrates,  i.  12. 

3  Traite  des  Marais,  201 . 

4  Diseases  of  Seamen,   117,  287;  see  also  Blane's  Dissertation,  i.  220;  Folchi,  N. 
A.  Med.  and  Surg.  Journ.  vii.  252 ;  J.  Clark,  G7. 

6  Savaresi,  451 ;  Dariste,  227  ;  Bally,  591 ;  Valentin,  233  ;  Arnold,  18;  Robert,  574  ; 
Townscnd,  223;  Cullom,  3G5;  Guyton  Morveaux,  Carmichael  Smith,  Playfair,  Gra 
ham,  Hoffman,  Cooper,  in  Sec.  Ptcpt.  of  London  Commissioners,  1848,  p.  32,  &c. 

6  Bowie,  in  same  work,  83. 

7  Johnson,  Some  Account  of  the  Origin  and  Prevalence  of  Yellow  Fever  in  Charles 
ton,  Charleston  Journ.  iv.  164  ;  Southern  Agriculturist,  iv.  250,  417,  as  quoted  by  Dr. 
Johnson. 

8  Bryson,  225. 


AUTUMXAL    FEVERS.  277 

in  Germany,  France,  and  elsewhere,  on  land  and  on  shipboard;1 
as  well  as  of  the  sprinkling  of  lime,2  and  of  ozone,  the  most  power 
ful  of  disinfectants.3 

Dr.  Stokes  relates  somewhere  the  instance  of  a  district  of  Corn 
wall,  where  paludal  fevers  prevailed  extensively,  and  have  disap 
peared  since  the  establishment  of  a  copper  foundry.  It  is  known 
that  daring  the  fusion  of  copper,  an  escape  of  arsenical  particles 
takes  place.  In  this  respect  malarial  diseases  approximate  to  those 
produced  by  animal  poisons.  M.  Bousquet  has  found  that  the 

1  Zimmerman,  de  1'Experience,  notes  by  the  translator.     Bonnet,  Essai  sur  la  Puri 
fication  de  1'Air,  17;   see  also  Hoffman  and  Van  Swieten.     Galeron,  Mem.  de  la  Soc. 
Hoy.  de  Med.  iii.  44 ;  Lind  on  Seamen,  74. 

2  Forbes's  Review,  July,  1844,  p.  196. 

8  This  substance,  which  at  one  time  was  supposed  to  constitute  the  efficient  cause 
of  epidemic  diseases,  because  it  is  sometimes  found  in  the  atmosphere  during  the 
prevalence  of  these,  may  now,  if  the  experiments  of  Dr.  Schoebein1  are  to  be  relied 
upon — and,  so  far,  no  doubts  have  been  expressed  on  the  subject — be  considered  as 
the  most  powerful  disinfectant,  and  the  great  purifier  of  the  atmosphere.  It  destroys, 
quietly  and  effectually,  the  miasma  disengaged  from  putrid  flesh ;  and  there  is  every 
reason  to  believe  that  it  acts  as  efficiently  in  regard  to  the  cause  of  fever,  as  to 
atmospheric  poisons,  artificially  produced ;  whilst  its  effects  in  respect  to  these  and 
its  virtues  as  a  destroyer  of  the  cause  in  question,  lend  a  strong  support  to  the  opinion 
which  ascribes  fever  to  the  existence,  in  the  air,  of  peculiar  poisonous  exhalations. 
Ozone  is  abundantly  found  during  thunderstorms,  and  we  know  that  these  purify  the 
atmosphere,  mitigating  or  arresting  the  spread  of  epidemic  fever.  If  it  is  diminished 
in  volume,  by  the  presence  of  impurities  artificially  produced,  and  whose  presence  in 
the  atmosphere  cannot  be  doubted,  it  is,  in  like  manner,  found  in  less  quantity  in  hot 
seasons  and  fever  regions,  where  malaria  may  be  supposed  to  exist  in  greater  abund 
ance  ;  and  if,  in  the  former  case,  the  diminution  in  question  is  produced  by  the  action 
of  the  disinfectant,  in  neutralizing  or  destroying  the  existing  impurity,  we  cannot 
greatly  err  in  referring  the  diminution,  in  the  latter  case,  to  a  like  action  of  that  sub 
stance  on  a  kindred  poison,  and  its  consequent  consumption.  Ozone,  on  the  other 
hand,  exists  in  greater  abundance  in  winter  ;  and,  as  this  is  precisely  the  season  at 
which  miasmal  fevers  do  not  prevail,  and  when  the  atmosphere  is  in  the  greatest  state 
of  purity,  we  are  justifiable  in  the  conclusion  that  its  accumulation,  at  that  period, 
arises  from  a  less  demand  of  it  for  the  decomposition  of  oxiclable  miasmatic  matter  or 
poison.  Again,  it  has  been  found  that  the  higher  stratas  of  the  atmosphere  are  more 
ozoniferous  than  the  lower  ones,  an  effect  easily  accounted  for  by  the  circumstance 
that  those  strata  contain  a  less  quantity  of  that  oxidable  miasmatic  matter  than  those 
portions  of  the  atmosphere  which  are  nearer  the  surface  of  the  earth,  and  that  hence 
a  smaller  quantity  of  the  disinfectant  substance  is  consumed.  In  a  word,  ozone  acts 
like  chlorine,  by  destroying  impurities  existing  in  the  atmosphere ;  and,  if  it  purifies 
the  air  of  infected  localities,  and  destroys  the  cause  of  fever,  it  can  only  do  so  by 
destroying  or  neutralizing  a  kindred  impurity,  or  poisonous  exhalation,  floating  in  the 
atmosphere  of  such  localities. 


Med.-Chir.  Trans,  xxxiv.  212. 


278  PNEUMONIA    AND 

chlorides  produce  an  important  change  in  the  vaccine  matter,  and7 
indeed,  annihilate  its  specific  property,  when  the  mixture  is  pro 
perly  made  and  somewhat  prolonged.1  The  syphilitic  virus,  ac 
cording  to  Ricord,  unless  not  very  much  diluted,  is  not  affected  by 
mixture  with  saliva,  urine,  vaginal  mucus,  muco-purulent  matter  of 
the  urethra  or  vagina,  fecal  matter,  sweat,  or  sperm  ;  but  is  destroyed 
by  an  alkali,  or  an  acid,  as  the  sulphuric,  nitric,  chlorhydric,  acetic, 
&c. ;  by  chlorides,  potas.h,  soda,  ammonia,  wine,  alcohol,  concentrated 
decoction  of  tan.2  Vaccine  matter  is  destroyed  by  great  heat,3  and 
by  frost.4 

Cause  arrested  "by  trees,  &c. — The  extension  or  diffusion  of  the 
cause  is  arrested  by  trees,  walls,  hills,  rows  of  buildings,  canvas,  and 
other  such  obstacles.5  Lancisi  cites  a  number  of  facts  showing  the 
advantages  of  belts  of  trees  in  protecting  against  the  effects  of 
malaria,  and  the  danger  resulting  from  their  removal.  He  calls 
attention  to  the  fact  that,  in  former  days,  there  existed  on  the  south 
side  of  Home  a  thick  forest.  It  extended  from  Frascati  and  Albano 
to  the  Tiber,  and  protected  the  southern  portion  of  the  city,  and  the 
neighbouring  district,  from  the  baneful  influence  of  the  effluvia  of 
the  Pontine  Marshes.  This  rampart  has  since  been  removed,  and 
the  country  has  become  proverbial  for  its  unhealthiness. 

Lancisi  did  not  for  a  moment  doubt  the  utility  of  these  belts, 
and  expresses  the  opinion  that  the  consecration  by  the  ancients  of 
woods  and  groves  had  no  other  motive  than  guarding,  through 
their  means,  against  the  diffusion  of  the  febriferous  poison.6  In  this, 
he  was  probably  right.  Among  the  Eomans,  the  advantage  of 
such  barriers  had  long  been  recognized.  Trees  were  planted  in 
rows  and  in  masses,  to  guard  against  the  diffusion  of  malaria.  The 
practice  was  enforced  by  law,  and  recorded  on  the  Roman  tablets. 
This  law,  which  was  reported  by  Cicero — "Lucos  in  agris  htibinto"- 

1  Nouvcaux  Traite  cle  la  Vaccine,  220. 

2  Tr.  Prat,  des  Malad.  Vener,  178  ;   Lcttrcs  J.  86. 

3  Anglada,  i.  213.  4  Bulletin,  ii.  10-51. 

5  Rigault  de  1'Isle,  in  Johnson,  Trop.  Cl.  807,  314,  310,  317;   Mitchell  (J.  K.j,  20, 
100;   Macculloch,    110,252,3;    Williams,    Morbid  Poisons,   ii.    4-18,   453  ;    Johnson, 
Change  of  Air,  143;   Evans,  15;   Caldwcll  on  Malaria,  135;   Tonrnon,  foe.  fit.  \.  200; 
Watson's  Practice,  453;  Bonnet,  Fiev.  Interni.  311  ;  Drake,  i.  727;  Monfaleon,  (J3,  04, 
160;  Annesley  on  Diseases  of  India;  Wilson  Philip,  on  Fevers,  i.  70;   Tfosack,  Prac 
tice,  174;  Dundas,  Sketches  of  Brazil,  240;  DC  Ilerizi  Miasmi  Paludosi,  30. 

6  Op.  dt.  8'J,  &c. 


AUTUMNAL    FEVEKS.  279 

bad  reference  evidently  much  more  to  the  advantage  in  question, 
than  to  the  purposes  for  which  trees  are  usually  planted.  In  order 
to  insure  their  safety,  such  collections  of  trees  were  placed  under 
the  protection  of  some  divinity,  or  under  the  responsibility  of  the 
Roman  consuls. 

"  Sive  sacro  pavi,  sedive  sub  arbori  sacra,"  says  Ovid. 

"  Si  canirnus  sylvas,  sylvae  sint  consula  dignas,"  according  to 
Suetonius. 

Bapt.  Donus,  in  his  work  on  the  means  of  insuring  salubrity  to 
the  soil  of  the  Roman  States,  recommends  the  planting  of  pine  and 
other  trees  between  Rome  and  the  Pontine  Marshes,  to  intercept 
the  miasmata  wafted  from  these  by  the  south-west  winds.1  At 
Velletri,  as  also  at  Campo  Salino,  the  destruction  of  belts  of  woods 
was  followed  by  the  prevalence  of  fever. 

The  following  fact,  published  by  Dr.  Lewis  in  his  medical  history 
of  Alabama,  on  the  authority  of  Dr.  "Wooten,  at  present,  I  think, 
Professor  in  the  Medical  School  of  Memphis,  is  interesting  and  ap 
posite  :  "  Mr.  P.  E.  had  negro-quarters  situated  on  the  "first  prairie 
elevation  above  the  low  grounds  of  a  small  creek,  the  fourth  of  a 
mile  from  the  houses.  The  belt  of  low  ground  frequently  over 
flowed,  causing  water  to  remain  in  holes  over  its  entire  breadth,  on 
the  subsidence  of  the  stream,  but  it  was  well  shaded  by  a  dense 
foliage,  the  plantation  lying  on  the  prairie  in  the  rear  of  the  cabins. 
In  the  winters  of  1842  and  1843,  the  trees  between  the  houses  and 
creek  were  cleared  away ;  and  up  to  that  time,  some  eight  or  ten 
years,  the  negroes  living  in  this  quarter  had  enjoyed  uninter 
rupted  health,  a  case  of  fever  scarcely  ever  occurring.  During  the 
summer  of  18-13,  the  first  after  the  forest  had  been  cleared  away, 
fever  prevailed  among  the  negroes  with  great  violence,  continuing 
until  frost.  The  negro-quarters  were  afterwards  removed  to  the 
opposite  side  of  the  creek,  about  the  same  distance  from  it,  but 
with  an  intervening  growth  of  timber,  and  no  fever  has  occurred 
on  the  place  since."2 

"  Whole  families,"  says  Mr.  Bartlett,  "  have  resided  near  the  Pon 
tine  Marshes,  and,  by  the  intervention  of  shrubs  and  trees,  have 
escaped  for  years  the  noxious  effects  of  the  mephitic  vapours  which 
those  putrid  waters  engender."3  Dr.  Ilosack  states  that  a  family  in 

1  De  Rcstituencla  Salnbritatc  Agri  Romani,  1GG7. 

2  New  Orleans  Journal,  iv.  4.  3  Thompson's  Annals. 


280  PNEUMONIA    AND 

New  Jersey  was  attacked  with  fever  in  consequence  of  cutting  down 
a  wood  that  separated  them  from  a  morass  in  the  neighbourhood. 
Before  that  operation,  they  had  been  healthy.1  "  Army  physicians, 
therefore,  recommend,"  says  Dr.  "Wilson  Philip,  "  having  a  wood,  if 
possible,  between  marshy  grounds  and  an  encampment.''2  Rigault  de 
Lisle  calls  attention  to  the  fact  that,  upon  Mount  Argental,  above 
the  village  of  St.  Stephano,  there  is  a  convent,  which  has  lost  all 
the  reputation  for  salubrity  which  it  once  enjoyed,  since  the  lofty 
trees,  by  which  it  was  surrounded,  have  been  cut  down.  I  have 
been  informed,  he  adds,  by  persons  worthy  of  credit,  that,  in  con 
sequence  of  the  felling  of  the  wood  before  Astcrna,  near  the  Pontine 
Marshes,  Veletri  was  visited  for  three  successive  years  by  diseases 
which  made  much  greater  havoc  than  usual  throughout  the  whole 
country,  and  penetrated  to  many  places  which  they  had  not  pre 
viously  been  accustomed  to  reach.  Rigault  de  Lisle  cites  other 
cases,  and  refers  to  Yolney,  who  states  that  Beyroot,  formerly  very 
unhealthy,  has  ceased  to  be  so  since  the  Emir  Fakr-el-din  planted 
a  wood  of  fir-trees,  which  still  exists,  a  league  below  the  town. 

By  Pliny  and  others,  among  the  ancients,  it  was  supposed  that 
trees  absorb  the.  exhalations  extricated  from  insalubrious  places, 
and  that  the  beneficial  effects  obtained  from  woods  are  to  be 
accounted  for  in  this  way  much  more  than  by  the  obstacles  they 
offer  to  the  diffusion  of  those  exhalations.  This  opinion  has,  to 
a  certain  extent,  received  the  sanction  of  Thouvenelle,  Copland, 
and  other  modern  writers;  and  its  correctness  is  rendered  probable 
by  the  results  of  certain  experiments  made  long  ago,  and  repeated 
more  recently  to  ascertain  the  fact.  "  Plants,"  says  Julia  de  Fon- 
tenelle,  "which  Priestley  had  inclosed  in  glass  jars  filled  with  viti 
ated  air,  continued  to  thrive,  and,  at  the  end  of  a  few  days,  this  air 
had  become  as  pure  as  that  of  the  surrounding  atmosphere."3  A 
more  recent  writer,  Dr.  Lewis,  of  Mobile,  reverting  to  the  subject, 
remarks:  "  It  is  the  generally  received  opinion  that  living  vegetation 
protects  the  human  system  from  the  deleterious  effects  of  malaria; 
and,  reasoning  by  analogy,  it  would  appear  that  experiments  mado 
by  scientific  men  have  satisfactorily  explained  the  mutual  depend 
ence  of  the  animal  kingdoms  on  each  other  for  support.  It  has 
been  ascertained  that  if  air,  rendered  pernicious  by  respiration,  be 

1  rrnctico  of  Medicine,  174.  2  A  Treatise  on  Feb.  Di.s.  i.  71).   Am.  ed. 

3  Op.  cit.  139. 


AUTUMNAL    FEVERS.  281 

confined  in  a  bottle,  into  which  some  green  plant  has  been  intro 
duced,  and  exposed  to  the  action  of  the  sun,  the  carbonic  acid  will 
be  absorbed,  and  the  air  restored  to  its  original  condition.  The 
putrefaction  of  animal  matter,  and  the  decomposition  of  vegetable 
substances  would  cause  a  sufficiency  of  carbonic  acid  vapour,  when 
united  with  atmospheric  air,  to  destroy  every  living  being,  were  it 
not  for  this  wise  provision  of  nature.  This  gas,  which  is  poisonous 
to  the  human  as  well  as  animal  species,  is  a  source  of  nutriment 
to  every  variety  of  plant ;  and  thus,  it  would  appear,  exercises  a 
benign  influence  in  protecting  men  from  the  deleterious  effects 
of  poisonous  vapours."1  And  if  the  effect  is  obtained  so  far  as 
regards  one  species  of  poisonous  vapour,  it  may  be  equally  so  in 
reference  to  that  giving  rise  to  fever. 

Facts,  indeed,  are  not  wanting  to  show  that  aquatic  plants,  as 
well  as  certain  vegetable  substances,  growing  in  damp  and  swampy 
or  marshy  soils,  possess  the  property  of  disinfecting  them — a  virtue 
which,  as  is  well  known,  Dr.  Cartwright  ascribes  more  particularly 
to  the  Jussiena  Grandifolia,  an  exclusively  aquatic  plant  found  in 
great  abundance  in  some  parts  of  the  Southern  States,  and  espe 
cially  in  some  regions  of  Louisiana,  which,  though  presenting  many 
of  the  usual  characteristics  of  malarial  surfaces,  are  exempt  from 
fever.2 

A  distinguished  natural  philosopher,  Changeux,  inferred  from 
the  results  of  his  experiments,  that  the  action  of  trees  in  the  pro 
duction  of  the  effect  under  consideration  is  twofold.  "  Plants,"  he 
says,  "  whether  odoriferous  or  inodoriferous,  give  issue  to  emana 
tions,  which,  when  mixed  with  poisonous  vapours  exhaling  from 
marshy  or  damp  soils,  neutralize  their  pernicious  influence.  But 
the  former  exercise  a  greater  effect  through  means  of  the  neutral 
izing  process  than  by  the  power  of  absorption  just  mentioned; 
their  emanations  mixing  with  the  air  we  breathe,  and  correcting 
its  deleterious  properties  by  virtue  of  the  particular  qualities 
with  which  they  are  endowed.  The  second  class — the  inodorife 
rous,  on  the  other  hand,  act  more  evidently  through  means  of  their 
power  of  absorption  than  of  the  neutralizing  property  of  their  ema 
nation,  and  remove  from  the  air  the  vapours  by  which  it  is  con 
taminated."3 

1  Med.  Hist,  of  Alabama,  New  Orleans  Jo  urn.  iv.  4,  5. 

2  Western  Journal  of  Medicine  and  Surgery,  i.  428,  &c. 

3  Journal  de  Physique,  vi.  211. 


282  PNEUMONIA    AND 

By  not  a  few  able  observers  and  expert  experimentalists,  the  dis 
infection  is  ascribed,  not  to  the  absorption  by  trees  and  other  vege 
table  substances  of  the  gaseous  poison  floating  in  the  atmosphere 
of  malarial  localities,  but  to  the  purification  of  such  an  atmosphere 
through  means  of  the  large  supply  of  oxygen  obtained  from  living 
plants,  and  the  neutralizing  agency  of  that  gas  on  the  mephitic 
particles  it  meets  with  in  insalubrious  places.1  As  to  the  manner 
in  which  the  oxygen  thus  produced  destroys  or  prevents  the  elabo 
ration  of  the  malarial  poison,  some  difference  of  opinion  exists. 
M.  Carriere,  in  his  excellent  work  on  the  climate  of  Italy,  adopts 
the  views  of  Chevreul  and  Fontana,  in  relation  to  the  formation  of 
the  febrific  poison  through  means  of  the  action  of  organic  matter  on 
the  sulphates  contained  in  the  earth  or  in  water  with  the  aid  of  the 
oxygen  derived  from  the  former.  According  to  this  writer,  the 
leaves  of  plants  and  of  trees,  as  well  as  the  green  substances  that 
cover  the  soil,  are  all  inexhaustible  sources  of  oxygen,  which 
is  so  important  to  sustain  life  and  preserve  health.  This  fluid, 
thus  furnished,  offers  an  obstacle  to  the  action  of  organic  mat 
ter.  If  the  latter  acts  chemically  on  the  sulphates,  the  other,  in  its 
turn,  reacts  on  those  compounds,  and,  from  the  double  antagonistic 
action  thus  produced,  a  state  of  equilibrium,  advantageous  to  the 
purity  of  the  air  and  the  salubrity  of  the  country,  is  re-established. 
"  Hence,  to  cover  the  fields,  the  edges  of  marshes,  and  the  whole 
extent  of  the  soil  with  an  abundant  vegetation,  is  equal  to  placing 
on  the  surface  of  unhealthy  regions  a  reparative  apparatus  of  the 
greatest  power."  "  Trees,  therefore,  must  have  a  large  share  in  the 
amelioration  of  the  country,  in  consequence  of  the  quantity  of 
leaves  they  furnish."2 

By  others,  again,  it  has  been  remarked,  doubtless  with  much 
truth,  that  malaria  is  collected  by  plants,  particularly  those  of  a 
dense  and  entangling  foliage,  so  as  to  be  disengaged  on  cutting 
them  down  or  rooting  them  up,  thus  exciting  fever  in  the  labourers 
who  might  otherwise  have  escaped,  as  proved  by  the  circumstance 
that  in  all  those  situations  while  the  workmen  are  in  the  erect 
posture,  and  engaged  at  their  work,  they  escape  the  fever,  but  are 
attacked  if  they  sit,  and,  more  particularly,  if  they  lie  down  on  the 
ground — and  that  whether  they  sleep  or  not.3  Whether  these  views 

1  Scncbicr,  Physiologic  Yegetalc,  iii.  184,  &c. 

*  Le  Climat  de  1'Italie,  328.  3  Edin.  Rev.  xxxvi.  540. 


AUTUMNAL    FEVEKS.  283 

be  correct  or  otherwise;  or  whether  the  effect  is  generally  due  to 
the  mechanical  obstruction  trees  afford  to  the  transit  of  malaria 
from  its  source,  while  the  exemption  of  individuals  who  keep  the 
erect  posture,  and  their  liability  when  they  sit  or  lie  on  the  ground, 
are  to  be  explained  by  a  difference  in  the  amount  of  terrestrial  radia 
tion,  or  by  the  greater  quantity  of  contaminated  air  they  breathe,  I 
need  not  stop  to  inquire,  and  dismiss  the  subject  with  the  simple 
remark  that,  the  same  results  being  obtained  from  the  interception 
occasioned  by  walls,  houses,  hills,  &c.,  we  are  justified  in  inferring 
that  trees,  though  they  may  perhaps  act  as  absorbents,  act  also,  and 
principally,  in  the  mechanical  way  mentioned.  Be  this  as  it  may, 
Dr.  Ferguson,  calling  attention  to  the  attraction  of  marsh  poison  for, 
or  rather  its  adherence  to,  lofty  umbrageous  trees,  says  that  "this  is 
so  much  the  case  that  it  can  with  difficulty  be  separated  from  them ; 
and  that  in  the  territory  of  Guiana,  particularly,  where  these  trees 
abound,  it  is  wonderful  to  see  how  near  to  leeward  of  the  most  pes 
tiferous  marshes  the  settlers,  provided  they  have  this  security,  will 
venture — and  that  with  comparative  impunity — to  place  their  habi 
tations.  The  town  of  New  Amsterdam,  Berbice,  situated  within 
musket-shot  to  leeward  of  a  swamp  extremely  offensive  at  a  certain 
stage  of  dryness,  owes,  evidently,  its  ordinary  exemption  from  fever 
to  this  cause."  "A  still  better  instance  of  the  same,  and  with  the 
same  results,  may  be  seen  at  Paramaribo,  the  capital  of  Surinam, 
where  the  trade-wind,  that  regularly  ventilates  the  town,  and  ren 
ders  it  habitable,  blows  over  a  swamp  within  a  rnile  of  the  town, 
which,  fortunately  for  the  inhabitants,  is  covered  with  the  same 
description  of  trees."1  But  whatever  be  the  way  in  which  these 
operate  in  promoting  the  salubrity  of  malarial  localities,  the  effect 
tends  to  show  that  the  benefit  obtained  is  due  to  the  destruction  of 
a  poisonous  agent  floating  in  the  air,  or  to  the  obstacle  it  encounters 
in  its  passage  with  the  atmosphere  from  one  place  to  another. 

Fever  orrcstcdby  removing  sources  of  infection. — The  progress  of  fever 
has  been  arrested  by  the  clearing  and  washing  of  gutters,  streets, 
sinks,  and  sewers — by  the  removal  of  other  sources  of  effluvia ; 
while  in  ships,  as  we  have  already  seen,  epidemic  prevalences  of 
yellow  fever  have  been  arrested,  and  health  restored,  by  kindred 
means. 

1  Marsh  Poison,  in  vol.  of  Xotes  and  Rccol.  195,  6.  See  also  Williams  on  Morbid 
Poisons,  ii.  448. 


284  PNEUMONIA   AND 

Fever  sometimes  connected  with  the  existence  of  certain  fogs  or  mists. — 
Instances  are  on  record  in  which  the  surfaces  of  highly  insalubrious 
marshy  localities  have  been  found  at  particular  hours  of  the  day, 
covered  over  with  a  heavy  foggy  cloud  of  a  peculiar  character,  and 
which  carries  infection1  wherever  it  is  propelled;  while  ordinary 
fogs  in  the  vicinity,  or  elsewhere,  are  perfectly  innocuous,  so  far  as 
relates  to  the  production  of  autumnal  or  periodic  fevers.  Such 
was  the  case,  for  example,  in  Wilmington,  in  1798.  Such  also  has 
been  found  over  the  town  of  Huaura,  in  South  America,  where 
marshes  are  extensive.  There  malaria  is  stated  to  have  been  found 
distinctly  separate  from  the  atmosphere,  lying  at  an  average  of  two 
or  two  and  a  half  feet  above  the  marsh,  and  distinguished  by  a 
peculiar  kind  of  opalization,  which,  on  certain  changes  of  light, 
exhibited  a  yellowish  tint.2 

Allusion  has  already  been  made  to  the  smokes  of  the  African 
coast.  These  very  frequently,  if  not  generally,  carry  with  them 
the  seeds  or  cause  of  fever,  and,  while  doing  so,  impress  the  system 
in  a  different  way  from  ordinary  fogs.  In  a  case  mentioned  by 
Sir  J.  Pringle  on  the  authority  of  Mr.  Lauder,  surgeon  of  a  horse 
regiment,  the  meadows  and  marshes  on  each  side  of  the  road  which 
the  troops  had  to  pass  over  on  their  way  to  forage,  Avere  covered, 
at  an  early  hour,  with  a  thick  fog  of  an  offensive  smell,  which  he 
considered  as  the  chief  cause  of  the  sickness  which  affected  the 
men,  as  few  who  were  exposed  to  its  impression  escaped  an  attack.3 
Pringle  also  states  that,  in  1748,  the  nocturnal  fogs  near  the  inun 
dations,  were  thick  and  fetid.4  Dr.  J.  Johnson  states  that  when, 
at  Batavia,  the  land-breeze  came  off'  from  the  low  swampy  grounds 
about  the  place,  early  in  the  mornings,  it  brought  with  it  a  thick 
mist,  accompanied  by  a  very  fetid  smell ;  all  of  which  would  gra 
dually  go  off  as  the  sun  rose,  and  the  sea-breezes  set  in.  During 
the  prevalence  of  this  fetid  mist,,  many  people  complained  of  slight 
indisposition  in  the  head  and  stomach,  which,  likewise,  wrent  off  as 
the  sun  rose.5  We  know,  however,  that  all  do  not  get  well  who 
breathe  that  mist,  for  the  great  prevalence  of  fever  about  Batavia 
is  proverbial. 

The  following  case  occurred  in  St.  Lucia:  Two  men,  after  fmish- 

1  Vaughan's  Med.  Rep.  iii.  30. 

2  Von  Tschudi's  Travels  in  Peru.     See  Edinb.  Journ.  Ixix.  489.     Watson,  451. 

3  P.  178.  4  P.  03. 
6  Trop.  Climates,  127. 


AUTUMNAL   FEVERS.  285 

ing  their  day's  work,  before  returning  home,  were  occupied  in  haul 
ing  their  canoe  high  upon  the  beach,  close  to  the  most  dangerous 
part  of  a  large  swamp,  when  they  perceived,  immediately  to  wind 
ward,  a  small  cloud  of  vapour  gradually  approaching  them.  In  a 
short  time  they  were  enveloped  in  it.  One  of  them  fell  down,  ap 
parently  in  a  state  of  asphyxia,  and  the  other  was  so  affected  as  to 
be  unable  to  render  him  any  assistance.  The  latter  soon  recovered, 
while  the  other,  after  coming  to  sufficiently  to  be  led  home,  was  seized 
in  the  night  with  an  intense  ague,  during  which  the  surface  of  the 
body  was  cold,  the  countenance  expressed  great  anxiety,  and  the 
pulse  was  small  and  scarcely  perceptible.  The  patient  was  insensible 
to  surrounding  objects,  and  in  a  state  of  coma,  only  interrupted  by 
severe  convulsions.  This  cold  stage  continued  about  three  hours, 
and  was  followed  by  reaction  attended  with  coma  alternating  with 
delirium,  vomiting  of  mucosities,  and  pain  in  the  stomach  aggravated 
by  pressure  at  the  epigastrium.  A  remission  followed,  which,  in  its 
turn,  was  succeeded  by  another  paroxysm  equal  in  violence  to  the 
last,  except  that  the  cold  stage  was  scarcely  perceptible.  Death 
occurred  about  forty  hours  from  the  period  of  exposure.  On  dis 
section,  the  blood  was  found  fluid,  and  a  small  quantity  of  turbid 
serum  was  effused  between  the  arachnoid  and  pia  mater;  the  lungs 
were  somewhat  engorged,  and  the  stomach  was  intensely  inflamed, 
containing  two  or  three  ounces  of  blood  in  its  cavity.  The  other 
man  stated  that  the  vapour  had  no  perceptible  smell ;  that  it  was 
warm  and  moist,  like  steam,  stopped  the  respiration  for  a  moment, 
and  produced  a  sense  of  faintness  and  trembling  of  the  whole  body.1 

The  stagnant  latter  of  marshes  injurious  to  health. — Stagnant  water, 
particularly  that  contained  in  marshes  and  swamps,  cannot  support 
animal  life,  and  furnishes  no  element  for  the  sustenance  of  fish. 
The  discharge  of  such  water  into  ponds  or  lakes  has  not  unfrc- 
quently  given  rise  to  the  sudden  destruction  of  those  animals  con 
tained  therein.2  To  produce  such  an  effect,  it  must  contain  in  solu 
tion  some  poisonous  matter ;  and  if  so,  it  is  not  unreasonable  to 
suppose  that  this  poison  is  taken  up  with  the  vapour  absorbed  in 
the  atmosphere,  and  that  it  affects  those  who  are  exposed  to  the 
influence  of  the  latter. 

1  Evans,  R.,  Clinical  Treatise  on  the  Epidemic  Fevers  of  the  West  Indies,  21. 

2  Monfulcon,  44. 


286  PNEUMONIA    AND 

Nor  is  it  unreasonable  to  admit  that  the  water  of  paludal  sur 
faces — Of  marshes,  particularly — may,  when  used  as  drink,  give  rise 
to  diseases  similar  to  those  resulting  usually  from  the  action  of 
the  exhalations  evolved  from  them.  Centuries  ago,  Hippocrates, 
in  his  masterly  work  on  Airs,  Waters,  and  Places,  while  treating  in 
a  special  and  interesting  section  of  the  nature  and  morbid  effects  of 
such  water,  attributes  to  its  use  the  enlarged  spleen  so  frequently 
noticed  among  the  inhabitants  of  marshy  districts — a  pathological 
condition  which  we  now  view  as  one  of  the  effects  of  malarial  poi- 
sonin^;  and  though  there  can  be  no  doubt  that  this  deleterious  effect 

O  "  O 

is  usually  the  result  of  the  absorption  of  the  exhalation  in  a  gaseous 
form  through  the  agency  of  the  respiratory  process,  there  are  facts 
to  show  that  it  may  sometimes  arise  from  the  internal  use  of  water 
impregnated  with  the  poison.  M.  Boudin,  in  support  of  this  opi 
nion  relates  the  following  case:  A  Sardinian  vessel,  the  Argo,  left 
Bone  (Algeria)  in  Juty,  1834,  with  120  soldiers  in  good  health. 
During  the  passage  to  the  lazaretto  of  Marseilles,  thirteen  of  these 
soldiers  died,  and  at  the  arrival  of  the  vessel  ninety-eight  had  the 
fevers,  of  all  forms  and  types.  "While  such  was  the  case  among 
the  soldiers,  the  crew  remained  in  health.  On  inquiry,  it  was  found 
that  this  result  arose  from  the  fact  that  the  crew  had  made  use  of 
pure  water  they  had  procured  for  that  purpose,  while  the  soldiers 
had  been  obliged  to  content  themselves  with  water  derived  from  a 
marshy  locality  situate  near  Bone.  The  few  soldiers  who  escaped, 
were  those  who  had  purchased  water  from  the  Sardinian  sailors.1 
It  must  be  added  that  two  other  vessels  which  sailed  at  the  same 
time  from  Bone,  filled,  like  the  Argo,  with  soldiers,  but  in  which 
pure  water  was  used  by  these  as  well  as  by  the  crew,  arrived  at 
Marseilles  in  good  health.2 

The  following  fact,  related  by  Dr.  Drake,  on  the  authority  of  Dr. 
Trowbridge,  deserves,  on  more  accounts  than  one,  to  be  recorded. 
In  the  neighbourhood  of  Buffalo,  for  three  (but  not  successive) 
autumns,  a  local  epidemic  fever  occurred  among  about  twenty  fami 
lies,  who  drank,  or  otherwise  used  water,  from  the  same  spring.  It 
burst  out  beneath  a  ledge  of  limestone,  about  twenty-five  feet  below 
the  summit,  beyond  which,  at  the  distance  of  a  mile,  there  was  a 
piece  of  woodland  with  a  pond,  which  Dr.  Trowbridge  supposed  to 
be  the  source  of  the  spring;  for,  after  rains,  its  waters  became  tur- 

1  Boudin,  Fevers  Interm.  GG,  G7.  *  Ib.  G6ograph.  Mod.  55. 


AUTUMNAL    FEVERS.  287 

bid.  The  autumns  in  wliich  the  fever  prevailed  were  unusually 
dry.  In  its  symptoms  and  violence,  the  disease  might  have  passed 
for  yellow  fever.  Nine  or  ten  persons  died.  The  surrounding 
neighbourhood  remained  healthy.  The  spring  was  at  length  aban 
doned,  and  the  fever  did  not  return.  Dr.  Drake  remarks  that  this 
seems  to  show  that  the  material  cause  of  autumnal  fever  may  be 
absorbed  by  water,  and  thus  produce  its  characteristic  effects.1 

A  paludal  atmosphere  enfeebles  health. — The  feeble  health  entailed  by 
a  long  residence  in  fenny  and  fever  regions,  results  often  from  a 
frequent  repetition  of  febrile  attacks;  as,  frequently,  it  manifests 
itself  without  the  occurrence  of  open  fever — intermittent,  remittent, 
or  continuous.  It  depends  on  pathological  conditions  of  a  special 
kind,  characterized  by  phenomena  equally  peculiar,  and  indicates 
the  agency  of  a  morbific  cause  other  than  a  mere  modification  in  the 
relative  proportion  of  the  natural  constituents  of  the  atmosphere, 
or  in  the  thermometrical  or  hygrometrical  state  of  the  latter.  En 
largement  of  the  abdomen,  and  engorgement  of  its  viscera,  and 
a  morbid  state  of  the  blood,  consisting  in  the  simultaneous  dimi 
nution  in  the  proportion  of  the  globules,  of  the  albumen  of  the 
serum,  and  sometimes  of  the  fibrin,  attended  with  a  bloated,  pale, 
and  sallow  countenance,  a  flabbiness  of  the  flesh,  an  oedematous 
condition  of  the  cellular  tissue,  and,  in  some  localties,  a  disposition 
to  ulcers  and  to  gangrenous  sores,  are  frequently,  if  not  always 
encountered  in  such  regions,  and  have  been  noted  by  high  profes 
sional  authorities.2  The  evil  which  this  poison  inflicts  on  man 
is  painful  to  tell,  amounting  in  time  to  a  total  humiliating  degene 
racy  of  the  race.  The  late  Professor  Caldwell  remarks,  in  one  of 
his  works,3  that  those  who  would  witness  that  result,  in  its  highest 
degree,  must  visit  some  of  the  marshy  and  sickly  districts  of  Eu 
rope,  more  especially  of  France,  Holland,  Italy,  Spain,  and  Portu 
gal;  for  in  some  of  them,  where,  by  the  operation  of  the  poison, 

1  Diseases  of  the  Mississippi  Vallej^,  382. 

5  Fcclere,  Mod.  L<.'-g.  v.  165;  Nepple,  Fievrcs  Intermit.  11;  Boudin,  Fievres  Inter. 
188;  Diet,  dcs  Sc.  Med.,  article  Marais,  533;  Monfalcon,  viii.  114,  131;  Blair,  Y. 
Fev.  of  Demerara,  23;  Davy,  Notes  to  Blair;  Prony,  Rapport  sur  les  Mara  is  Pontines, 
Becquerel,  170,  1;  Edinb.  Med.  and  Surg.  Journ.  Ixxx.  212;  Tliouvenelle,  Climat 
de  1'Italie,  15,  16;  Copland,  art.  Endemic  Influences,  i.  701,  Am.  ed.  ;  Carriorc,  op. 
cit.  87  ;  De  Renzi,  Miasmi  Paludosi,  83. 

3  Essay  on  Malaria,  19. 


288  PNEUMONIA    AND 

through  a  long  and  unbroken  line  of  generations,  the  effect  has 
reached  its  maximum,  the  issue  is  deplorable.  The  adage,  which 
attributed  the  dulness  for  which  the  Boeotians  were  proverbial  to 
the  mists  and  paludal  nature  of  their  ill-favoured  country,  is  as  old 
as  the  time  of  the  ancient  Athenians,  and  shows  that,  at  an  early 
period,  the  cachectic  effect  of  such  localities  was  matter  of  ob 
servation.  Hippocrates  may  have  had  them  in  his  mind,  when,  in 
writing  the  famous  treatise  so  often  referred  to,  he  remarked,  that 
such  waters  "as  are  marshy  and  stagnant,  and  belong  to  lakes, 
are  necessarily  hot  in  summer,  thick,  and  have  a  strong  smell,  since 
they  have  no  current ;  but  being  constantly  supplied  by  rain  water, 
and  the  sun  heating  them,  they  necessarily  want  their  proper  co 
lour,  are  unwholesome,  and  form  bile.  Those  who  drink  them 
have  large  and  obstructed  spleens,  their  bellies  are  hard,  emaciated, 
and  hot ;  and  their  shoulders,  collar-bones,  and  faces  are  emaciated  ;^ 
for  their  flesh  is  melted  down  and  taken  up  by  the  spleen,  and 
hence  they  are  slender;  such  persons,  then,  are  voracious  and 
thirsty ;  their  bellies  are  very  dry,  both  above  and  below.  They  are 
very  subject  to  dropsies  of  a  most  fatal  character;  and,  in  summer, 
dysenteries,  diarrhoea,  and  protracted  quartan  fevers  frequently 
seize  them;  and  these  diseases,  when  prolonged,  dispose  such  con 
stitutions  to  dropsies,  and  thus  prove  fatal.  Women  are  subject  to 
oedema  and  leucophlegmasia.  The  children  are  particularly  subject 
to  hernia,  and  adults  to  variccs  and  ulcers  on  their  legs ;  so  that 
persons  with  such  constitutions  cannot  be  long  lived,  but,  before 
the  usual  period,  they  fall  into  a  state  of  premature  old  age."1 

Quod  si 

Judicium  subtile  videndis  artibus  illud 

Ad  libros  et  ad  lieec  musarum  dona  vocares 

Bo3otum  in  crasso  jxirares  acre  natum. — HORACE,  Episiol.  lib.  ii.  Ep.  2. 

Lancisi  did  not  fail  to  notice  the  undermining  effects  on  the  mind 
and  body  of  an  atmosphere  thus  vitiated,  and  closes  a  long  and  inter 
esting  chapter  on  the  subject  with  remarking,  "Adeo  colore  pallidi, 
vitibus  habetes,  ingenio  sunt  tardo,  muliebrique  ;"2  and  that  matters 
have  not  changed  in  that  respect  in  Italy,  since  his  days,  may  be 
easily  found  on  consulting  the  works  of  Carriere,  De  Kenzi,  Thou- 
venelle,  and  others. 

M.  Bosse  has  furnished  us  with  a  graphic  picture  of  the  condi- 

1  Airs,  Waters,  and  Places,  Adams's  Transl.  i.  195,  196.  2  Op.  at.  lib.  i.  70, 


AUTUMXAL    FEVERS.  289 

tion  of  the  inhabitants  of  the  malarial  districts  of  the  Department 
of  Ain  (formerly  the  province  of  Bresse),  in  France.  "A  pale 
and  livid  complexion,  a  dull  and  heavy  eye,  swollen  eyelids,  a 
wrinkled  face,  narrow  shoulders,  a  contracted  chest,  a  long  neck,  a 
shrill  voice,  a  skin  always  either  dry  or  bedewed  with  debilitating 
sweats,  a  slow  and  sluggish  walk,  &c.,  characterize  such  an  individual, 
who  is  old  at  thirty,  broken  and  decrepit  at  forty  or  fifty."1 

Not  different  is  it  in  the  malarial  districts  of  our  Southern  States, 
for  there  the  result  adverted  to  is  already  visible.  In  those  districts 
the  human  frame  is  weakly  constituted,  the  mortality  of  children 
very  great,  and  the  mean  duration  of  life  short.  "Along  the  fron 
tier  of  Florida,  and  the  southern  borders  of  Georgia,"  says  Dr.  Forry, 
"  as  well  as  in  the  low  lands  of  our  Southern  States  generally,  may 
be  seen  deplorable  examples  of  the  physical  and  perhaps  mental 
deterioration  induced  by  endemic  influences.  In  earliest  infancy, 
the  complexion  becomes  sallow,  and  the  eye  assumes  a  bilious  tint. 
Advancing  towards  the  years  of  maturity,  the  growth  is  arrested, 
the  limbs  become  attenuated,  and  the  viscera  engorged.  Boys  of 
fifteen  years  may  be  seen  bowed  down  with  premature  old  age — a 
mere  vegetating  being,  with  an  obstructed,  bloated,  and  dropsical 
system,  subject  to  periodic  fevers,  passive  hemorrhages,  and  those 
other  forms  of  disease  which  follow  in  the  train  of  malaria."2 

These  phenomena,  which  are  indicative  of  that  condition  of  the 
system  denominated  very  aptly  the  paludal  cachexia,  are  certainly 
not  the  usual  results  of  the  action  of  simple  heat,  cold,  moisture,  or 
atmospheric  vicissitudes,  or  of  the  introduction  into  the  system  of 
any  known  gas;  but  point  to  the  morbid  influence  of  some  spe 
cial  toxicological  agent  absorbed  into  the  circulation  along  with  the 
air  we  breathe,  and  possessing  a  twofold  action,  one  chronic  another 
acute;  the  former  producing  peculiar  bad  effects  in  the  blood,  in 
the  liver,  in  the  spleen,  and  the  whole  alimentary  canal  and  vascu 
lar  system  ;  the  other  giving  rise  to  periodic  fever. 

Dr.  Blair  remarks  that,  in  Demerara,  "  there  seems  to  be  both 
an  amemiatiny  and  a  septic  malaria.  The  former  pervades  the 
colony,  so  that  a  rosy  cheek  is  nowhere  to  be  found  after  a  year's 
residence  ;  but  it  least  affects  the  sea-shore.  Its  intensity  increases 
as  we  proceed  into  the  interior,  up  the  narrow  creeks  and  muddy 

1  Statistique  Jn  Department  de  FAin,  4. 

2  F.Tiy,  Climate  of  the  U.  S.  305,  3CG. 

19 


290  PNEUMONIA    AND 

rivers.  There,  the  complexion  becomes  perfectly  etiolated,  even 
without  an  attack  of  intermittent ;  the  spleen  gets  enlarged,  the 
cellular  tissue  infiltrated,  and  dyspnoea  and  palpitations  supervene 
from  mere  whiteness  (loss  of  the  red  particles)  and  thinness  of 
blood."  (P.  23.)  To  this  Dr.  Blair's  annotator,  Dr.  Davy,  adds  that 
such  an  influence  seems  to  be  common  in  the  West  Indies.  "  It  is 
strongly  marked  by  the  pale,  sallow,  sickly  hue  of  the  white  Creoles, 
especially  in  Barbacloes.  There,  if  they  have  any  colour,  it  is  most 
frequently  reddish ;  whence  the  labourers  of  this  class  have  been 
called  'red  legs.'  One  rarely  witnesses  that  bronzing  of 'the  ex 
posed  skin  in  the  West,  which  is  the  almost  constant  effect  of 
exposure  to  the  sun's  rays  in  the  East  Indies,  and  in  the  south  of 
Europe,"  (Ib.) 

In  many  southern  regions,  the  West  India  Islands,  for  example, 
malaria  predisposes,  as  Hippocrates  informs  us  was  the  case  in 
Greece,  to  ulcers.  Of  6,395  admissions  into  the  colonial  hospital 
of  Georgetown,  Demerara,  1,873  were  cases  of  ulcers.  Small  wounds 
produced  by  insects  and  serrated  grasses,  are  sufficient  to  excite  one 
in  subjects  so  predisposed.  The  ulcers  chiefly  affect  the  lower  ex 
tremities  ;  but  the  fingers  are  sometimes  affected,  and  even  the  lips 
and  cheeks.  In  the  negroes  they  are  often  large,  with  indurated 
edges,  and  produce  not  the  slightest  inconvenience,  except  in  the 
trouble  of  dressing  them.  Among  the  emigrants,  particularly  the 
Portuguese  and  the  Coolies,  the  ulcer  is  generally  sloughy,  phage- 
denic,  bleeding,  and  sometimes  a  perfect  sphacelus,  without  even 
surrounding  or  previous  erythema.  This  last  form  affects  those 
who  have  still  a  tolerably  healthy  appearance.  In  time,  the  soft 
and  solid  parts  are  speedily  destroyed,  and  if  amputation  be  found 
necessary,  gangrene  is  apt  to  attack  the  stump  within  twenty-four 
hours.  In  the  ansemiated  immigrant  Portuguese,  the  granulations 
are  pale,  and  the  progress  of  course  is  slow,  but  the  sore  will  heal 
kindly.1  Dr.  Blair  is  of  opinion  that  this  septic  modification  of  the 
malaria  (which  shows  itself  in  the  bleeding  gangrenous  ulcer)  is 
some  imperfect  development  of  the  yellow  fever  poison.  Dr.  Davy 
remarks,  in  support  of  this  view:  "In  Barbadoes,  among-  the 
white  natives,  who  are  almost  always  exempt  from  yellow  fever, 
the  mucous  membranes,  especially  of  the  prima?  via?,  and  the  skin, 
are  very  prone  to  diseased  action  of  a  kind  bearing  some  resem- 

1  Blair,  23. 


AUTUMNAL    FEVEKS.  291 

bianco  to  what  is  witnessed  in  yellow  fever;  for  instance,  the  chap 
ping  of  the  lips,  with  ulceration  and  bleeding ;  an  aphthous  or 
slightly  ulcerated  state  of  the  fauces,  and  probably  of  the  gullet  and 
stomach ;  the  yellowish  sallowness  of  skin,  with  tendency  to  ulcera 
tion.  I  may  add  that,  during  the  absence  of  yellow  fever  amongst 
the  troops,  a  disposition  to  purpura  hsemorrhagica  is  occasionally 
witnessed."1 

Effect  of  a  paludal  atmosphere  on  the  duration  of  life. — Nor  is  it  to 
be  forgotten  that,  for  the  above  reason,  a  paludal  atmosphere  has 
the  effect  of  shortening  the  duration  of  life.  Dr.  E.  Jackson  states, 
as  the  result  of  observations  made  during  the  period  of  our  revolu 
tionary  Avar,  that  white  females,  born  and  constantly  residing  in  the 
lower  districts  of  Georgia,  were  seldom  observed  to  live  beyond  the 
age  of  forty,  and  males  of  fifty.  lie  adds,  that  he  was  credibly 
informed  there  was  not  on  record  an  instance  of  a  person  born  at 
Petersburg,  Va.,  and  constantly  residing  there,  who  had  lived  to 
the  age  of  twenty-one.2  Either  the  distinguished  writer  was  misin 
formed,  or  matters  have  greatly  improved  in  that  vicinity  ;  for  the 
average  duration  of  life  is  infinitely  greater  now  than  he  represents 
it  to  be.  But  still,  at  present,  the  fenny  districts  of  Virginia  give 
but  a  low  average.  Dr.  James  Johnson  found  that  in  the  valleys  of 
Beveland  and  Walcheren,  the  peasants  exhibited  conspicuous  marks 
of  premature  old  age,  and  seldom  reached  beyond  fifty-five  or  sixty 
years.3  According  to  Sausset,  the  average  duration  in  fenny 
countries  is  not  over  twenty-six  years.  In  many  districts  of 
France,  it  does  not  exceed  twenty-two. 

Eozior,  quoted  by  Monfalcon,  fixes  at  fifty  years  the  farthest 
limit  of  human  life  of  the  inhabitants  of  Lower  Brittany ;  the  old 
age  of  whom,  when  they  have  attained  this  point,  bears  a  great 
resemblance  to  that  of  individuals  who,  in  salubrious  countries, 
have  reached  to  ninety.4  It  would  be  difficult  to  find  a  locality 
where  other  than  a  lexicological  cause  could  produce  such  disas 
trous  results  on  an  entire  population.  From  the  researches  of  M. 
Fleuriau  dc  Belle vue,  we  learn  that  the  mortality  of  some  com 
munes  around  Marenne  amounts  to  one  in  thirteen,  and  that  that  of 
the  Canton  of  Brouage,  during  a  period  of  sixteen  years — 1817- 

1  F.  i1 1.  note.  2  Treatise  on  the  Fevers  of  Jamaica,  77,  80. 

3  Trop.  Cl.  41.  4  Op.  cit.  134. 


292  PNEUMONIA    AND 

1832,  presents  a  proportion  of  one  to  twenty-one.1  The  same 
writer  remarks,  in  farther  illustration  of  the  deleterious  effects  of 
paludal  localities,  in  relation  to  the  subject  under  consideration, 
that  inundated  and  well-shaded  marshes  were  found  to  be  as  healthy 
as  dry  and  well-cultivated  fields — the  mortality  being  one  in  from 
42  to  46 ;  that  in  districts  possessing  a  purely  compact  argillaceous 
soil,  unsheltered  from  the  rays  of  the  sun,  and  on  which  rain-water 
remains  stagnant  for  some  time,  the  mortality  was  one  in  25,  and  even 
one  in  20 ;  and  that  in  five  cantons  containing  several  large  regular 
marshes,  the  mortality  amounted  to  one  in  18,  and  even  reached  as 
high  as  one  in  16.2  In  the  Bresse  and  Dombes,  the  proportion  is  also 
one  to  twenty-one ;  while  in  the  immediate  vicinity,  the  proportion 
is  much  less  unfavourable,  being  from  1  to  25.6  to  one  to  26. 7.3  In 
the  Department  of  Loiret  (canton  of  La  Ferte  and  Sully,  but  not 
including  the  town  of  Sully),  the  average  duration  of  life  is  23.33 
years.  In  the  Department  of  Loir  et  Cher  (cantons  of  La  Motte, 
Beuvron,  Neung,  Eomorantin,  and  Salbris),  the  average  is  29.41. 
In  other  less  malarial  cantons,  it  is  30.04,  30.64,  and  34.34.4 

France,  taken  in  its  ensemble,  exhibits  a  loss  on  one  in  about 
forty ;  from  which  it  follows  that  the  number  of  deaths  in  the 
aforesaid  malarial  districts  is  twice  as  large  as  it  is  in  the  country 
generally,  and  that  the  average  of  life  is  proportionably  less. 
Among  children,  the  loss  has  been  particularly  large,  amounting 
during  the  first  year  to  thirty-two  per  cent. ;  and  in  some  communes 
to  forty-two  per  cent.,  or  four-tenths  (near  one-half),  while  in  the 
entire  of  France  the  proportion  is  only  twenty-three  or  twenty-four 
per  cent.5 

To  the  same  effect,  I  may  call  attention  to  a  fact  mentioned  by 
Dr.  Price,  in  a  work  which  has  justly  acquired  a  great  reputation. 
Referring  to  the  District  of  Yaud,  in  the  Canton  of  Berne  (Switzer 
land),  the  population  of  which  amounted  to  one  hundred  and  sixty- 
nine  families,  representing  a  total  of  six  hundred  and  ninety-six  indi 
viduals,  he  remarks  that  of  these,  one-half  of  all  born  in  the  mount 
ains  live  to  the  age  of  forty-seven ;  whereas,  one-half  of  all'  born  in 

1  Statistique  de  la  Cliarente  Inferieur,  quoted  by  Melier,  Mem.  de  1'Ac.  do  Med. 
xiii.  GG7. 

2  Comptes  de  1'Acad.  des  Sc.  xxv.  338,  330. 

3  Fodere,  Medecinc  Legale,  v.  103;  Nepple,  Fiev.  Intcrm.  11. 

4  Becquerel,  Des  Climats,  2G5,  2G6. 

5  Mem.  de  1'Acad.  de  Medecine,  xiii.  GOT. 


AUTUMNAL   FEVERS.  293 

the  marshy  portion  of  the  district,  reach  only  to  the  age  of  twenty- 
five.  One  in  twenty,  of  all  born  on  the  hills,  live  to  eighty ;  only 
one  in  fifty-two  attain  this  age  in  the  marshy  portion.  Hence,  he 
observes,  the  probabilities  of  living  are  highest  in  the  most  hilly 
parts  of  the  district,  and  lowest  in  the  marshy.  In  the  former,  a 
person  aged  forty  has  a  chance  of  eighty  to  one  for  living  a  year. 
In  the  marshy  localities  of  the  district,  his  chance  is  not  thirty  to 
one  for  living  a  year.  In  the  former,  again,  persons  aged  twenty, 
thirty,  and  forty,  have  an  even  chance  for  living  to  forty-one,  thirty- 
three,  and  twenty-five  years  respectively ;  in  the  latter,  on  the  other 
hand,  persons  at  these  ages,  have  an  even  chance  of  living  only 
thirty,  twenty,  and  fifteen  years.1 

The  effects  of  malaria  on  population  are  well  illustrated  by  the 
results  of  observations  made  in  the  Pontine  Marshes,  where,  not 
withstanding  the  great  ameliorations  effected  in  their  condition 
from  1801  to  1811,  the  mortality  has  almost  always  exceeded  the 
births :  - 

Localities. 
VELLETRI.  SERRA.  POPERIXO.        SORINOI.  Total. 

Deaths  .     .     2,313  3,181  1,717  901  8,112 

Births  .     .     1,786  3,338  1,601  885  7,610 

Even  in  France,  where  malarial  fevers  are  not  as  malignant  as 
they  are  in  warmer  latitudes,  the  difference  is  considerable.  Take 
the  ten  most  malarial  departments,  and  compare  them  with  the  ten 
least  so,  and  it  will  be  found,  in  18-16,  that  the  former  presented  a 
smaller  proportion  of  births  and  a  larger  proportion  of  deaths  than 
the  latter: — 

Ten  least  malarial  departments.          Ten  most  malarial  departments. 

Births   ....     1  in  31.09  1  in  3-1.40 

Deaths  ....     1  in  46.61  1  in  41.08 

Increase  of  population        TJ5  T~9~42 

Cause  of  fever  produces  an  impress  of  greater  or  less  strength  on  all 
placed  under  its  influence. — The  existence  of  a  peculiar  morbific  agent 
floating  in  the  atmosphere  of  malarial  localities,  and  differing  from 
the  causes  of  ordinary  diseases,  may  be  inferred  from  the  fact  that 

1  Annuities  and  Lives,  ii.  29  ;   ib.  Letter  to  Dr.  Horsier,  on  "Insalubrity  of  Marshy 
Situations,"  Philos.  Tr.  of  London,  Ixiv.  06.      See  also  Sir  J.  Sinclair,  Principles  of 
Hygiene,  84. 

2  Becmiercl,  Tr.  Elem.  d'Hyg.  Privee  et  Publique,  103. 


294  PNEUMONIA    AXD 

in  such  localities  all  individuals  are  more  or  less,  especially  in  times 
of  severe  epidemics,  under  the  influence  of  the  cause,  and,  without 
being  necessarily  ill,  give  evidence  of  that  influence  by  presenting 
in  a  minor  form  some  of  the  symptoms  of  the  prevailing  disease. 
By  those  who  have  noticed  the  progress  of  Asiatic  Cholera,  and  of 
the  wide-spreading  Pneumonia  Typhoides  which  traversed  this 
country  in  1812,  1813,  and  who  have  read  of  the  sweating  disease 
of  1483-85,  and  of  the  Black  Plague  of  the  Middle  Ages,  it  will  be 
remembered  that  besides  the  many  who  were  attacked  with  those 
complaints  in  full  force,  thousands  suffered  from  some  one  or  more 
of  their  characteristic  marks  in  a  mitigated  form.  Phenomena  of 
an  analogous  kind  result  from  the  action  of  the  causes  giving  rise  to 
remittent  and  intermittent  fevers,  yellow  fever,  and  other  affections 
of  similar  nature;  for,  during  the  prevalence  of  epidemics  of  these, 
a  large  number  of  individuals  exposed  suffer  from  slight  indisposi 
tions,  and  exhibit  in  a  variety  of  ways  the  impress  of  the  morbific 
agent.  On  this  subject,  the  facts  recorded  by  Eush,1  Mitchell,2 
Potter,3  Archer,4  Schnurrer,5  Boudin,6  Holmes,7  Chervin,8  Pariset,9 
Perlee,10  and  others,  leave  no  doubt;  and  show  the  effect  to  have 
borne  on  the  eyes,  on  the  secretions,  on  the  alimentary  canal,  on 
the  brain  and  nerves,  and  on  the  blood.  All  this  is  explainable  on 
the  supposition  of  a  toxical  agent  floating  in  the  atmosphere  and 
producing  a  morbid  impress  of  greater  or  less  force  on  all,  but 
cannot  be  accounted  for  if  we  refer  the  disease  to  the  operation  of 
heat,  cold,  humidity,  atmospheric  vicissitudes;  in  a  word,  to  any 
known  modification  in  the  sensible  qualities  of  the  air. 

Kindred  phenomena,  resulting  from  the  gradual  operation  of 
morbid  agents,  the  true  toxical  nature  of  which  is  undeniable,  are 
matters  of  frequent  observation,  and  serve  to  confirm  the  views  here 
suggested.  M.  Tanquerel  des  Planches,  in  his  excellent  work  on 
lead  diseases,  remarks:  "Saturnine  preparations,  when  introduced 
into  the  system,  indicate  their  presence  there  before  the  manifesta 
tion  of  lead  diseases  by  a  specific  action  on  most  of  the  solids  and 
fluids."  This  action,  which  he  denominates  primitive  introduc- 

1  Vol.  iii.  84,  85.  2  Med.  and  Pliilos.  Register,  iv.  188. 

3  On  Contagion,  55.  4  Med.  Recorder,  v.  (58. 

5  Matcriaux  pour  servir  a  une  doctrine  des  epidemics,  40. 

6  Fievres  Interm.  188.  7  Am.  J.  of  Med.  Sci.  X.  S.  xii.  80S. 
8  Fievre  J.  d'Espagne,  174.  9  Fievre  J.  de  Barcelone,  27. 

10  Philad.  Med.  and  Physical  J.  iii.  12,  13. 


AUTUMNAL    FEVERS.  295 

tion,  consists  in,  1st,  a  peculiar  discoloration  of  the  teeth,  and 
lining  membrane  of  the  mouth;  2d,  the  saturnine  smell,  taste,  and 
breath ;  od,  the  saturnine  action,  or  yellow  leaden  hue  of  the  coun 
tenance  ;  -itli,  the  remarkable  emaciation  of  the  face.1 

The  cause  of  autumnal  fevers  produce  an  impress  on  the  lower  order 
of  animals  and  on  vegetables. — The  cause  giving  rise  to  the  febrile 
affections,  which  are  usually  referred  to  some  one  or  other  of  the 
modifications  of  malaria,  extends  its  influence  to  the  lower  orders  of 
the  animal  creation,  and  even  to  vegetables.  In  this  and  other  cities 
of  the  United  States  epidemics  of  malignant  fever  have  often  been 
ushered  in  and  accompanied  by  sickness  among  cats,  dogs,  hogs, 
&c.2  Similar  observations  have  been  made  elsewhere — the  symptoms 
being  often  analogous  to  those  of  the  reigning  disease,3  while  epi 
demic  seasons  have  often  been  found  marked  by  a  great  predomi 
nance  of  insect  life.  The  coincidence  of  blight  with  pestilence  has 
been  recorded  from  ancient  times.  M.  Dupuy  has  seen  a  number 
of  oxen  perish  with  symptoms  perfectly  analogous  to  those  of  inter 
mittent  fever,  after  having  pastured  in  a  highly  marshy  locality. 
In  1826,  after  the  overflow  of  the  Eiver  Manse,  an  intermittent  epi 
demic  broke  out  among  horses,  and  occasioned  a  considerable  mor 
tality.  Lancisi  relates  that,  in  1713,  during  the  prevalence  of 
intermittent  fevers,  an  epizooty  carried  off  thirty  thousand  oxen."4 
It  should  be  added,  also,  that  marshes  occasion,  among  many  ani 
mals,  "  a  chronic  endemy,  perfectly  analogous  to  that  produced  in 
the  human  species.  The  prolonged  sojourn  and  pasturage  of  sheep 
in  marshy  localities  produce  in  them  the  hydroosmia,  a  disease  cha 
racterized  by  a  diminution  in  the  proportion  of  the  blood-globules, 
as  also  by  a  notable  one  in  the  quantity  of  the  serum,  and  which, 

1  Sec  also  Adams's  R.ept.  in  Trans,  of  Am.  Mod.  Assoc.  v.  171,  172. 

2  Med.  Repos.  i.  250,  254,5,  351;   Smith  (E.  H.)  Fev.  of  N.  Y.  76;  Cakhvell,  133, 
109  ;  ib.  fever  of  1805,  pp.  40,  61 ;   Condie  and  Fohvell,  15  ;   Rush,  iv.  8;  Shccut,  77  ; 
Yanghan,  18  ;  Cartwright,  Recorder,  ix.  7  ;  Baxter's  Med.  Repos.  xxi.  6,  7  ;  Chap 
man,  Med.  and  Phy.  J.  ix.  395,  0  ;   Kilpatrick,  N.  0.  J.  ii.  43;  Seaman  Webster's  Col 
lection,  3  ;   Thouvenelie,  iv.  200-202. 

3  Smith,  Edinb.  J.  xxxv.  36;   Maclean  on  Epid.  i.   289;   Sir  J.  Fellows,  45,  236; 
Cycl.   of  Tract.   Med.  ii.   74;  Pariset,  67-69;   Osborri,    70;   Pinckard,   i.   138;   Des- 
portes,  i.  17;   Arojula,  286,  331;   Ralph,  Ed.  Med.-Chir.  Tr.  ii.   58;  O'Halloran,  26; 
Melier,  loc.   cit.  669;   Rep't  on  Quarantine,   London,  13;    Second  Rep.  39,  865;   Mo- 
reaii  do  Jonnes,  112;   King's   Rep't  on  Fever  of  Boa  Vista,  9;  Blair,  63;  Boudin, 
Fiev.  Int.  135;   Monfalcon,  502. 

4  Laucisi,  De  Boville  Peste,  2,  &c. 


296  PNEUMONIA    AND 

consequently,  is  analogous  to  the  paludal  cacliexia  of  men."  M. 
Gasparin  reproduced  this  disease  in  sheep  by  causing  them  to  drink 
and  to  be  rubbed  with  the  condensed  vapour  obtained  from  marshy 
surfaces. l 

Mr.  Chad  wick  informs  us  that  in  the  course  of  the  inquiries  as  to 
what  has  been  the  effect  of  drainage  upon  health,  one  frequent 
piece  of  information  received  has  been,  that  the  rural  population 
has  not  observed  the  effects  on  their  own  health,  but  they  have 
marked  the  effects  of  drainage  on  the  health  and  improvement  of 
the  stock.  Thus,  the  less  frequent  losses  of  stock  from  epidemics 
are  beginning  to  be  perceived  as  accompanying  the  benefits  of 
drainage,  in  addition  to  those  of  increased  vegetable  production.2 

The  General  Board  of  Health  of  London,  in  their  Report  on  the 
practical  application  of  sewer-water  and  town  manures,  already  re 
ferred  to,  remark  that  the  injurious  effects  upon  health,  of  the  pro 
longed  retention  of  excessive  moisture  on  a  surface  of  vegetable 
mould,  is  established  by  the  production  of  rot  amongst  sheep — an 
effect  which  sheep-feeders  have  produced  by  stocking  closes  just 
after  they  had  been  flooded,  and  whilst  they  were  saturated  with 
moisture.3 

In  his  examination  before  the  Metropolitan  Sanitary  Commis 
sioners,  already  referred  to  in  a  former  chapter,  Mr.  Smith,  after 
speaking  of  the  beneficial  effects  of  draining  on  the  healthiness  of 
malarious  localities,  remarks  that  it  is  generally  observed  by  the 
inhabitants,  that  their  cattle  or  stock  are  now  less  subject  to  dis 
eases.  In  a  farm  in  the  west  of  Perthshire,  the  cattle  were  very 
subject  to  the  disease  called  "red  .water;"  since  the  draining,  there 
has  been  no  case  of  that  disease.  In  other  parts  of  Scotland  and 
England,  similar  results  are  stated  to  have  followed  the  introduction 
of  thorough  drainage. 

Mr.  Parker  stated  that  the  disease  of  foothalt  in  sheep  and  deer 
has  been  perfectly  removed  in  many  gentlemen's  parks,  and  in  ex 
tensive  pasturage  grounds,  by  deep  under  drainage. 

"  In  the  Highlands,"  Mr.  Spooner  remarked,  "  and  more  particu 
larly  on  the  west  coast,  there  exists  a  well  known  and  fatal  disease 
among  slice}),  incurable  by  any  treatment,  termed  '  Braxey/  which 
on  undrained  land,  and  in  wet  seasons,  is  a  cause  of  very  serious 

1  Becquerel,  Hydene,  18:1,  194,  105. 

2  Second  llep't  of  Commissioners  of  Inq.  into  the  State  of  Large  Towns. 

3  P.  9,  London,  1852. 


AUTUMNAL    FEVERS.  297 

losses.  This  is,  in  a  great  measure,  prevented  by  drainage,  and  the 
diminution  of  casualties  alone  is  more  than  sufficient  to  cover  its 
cost,  independently  of  the  increased  quantity  and  better  quality  of 
the  fodder  produced.  This  system  has  been  extensively  practised 
for  several  years,  and  invariably  with  the  same  beneficial  results. 
As  to  the  health  of  cattle  or  stock,"  he  added,  "  I  have  the  strongest 
evidence  of  the  beneficial  effects  of  drainage  in  many  instances.  On 
the  lands  which  I  possess,  and  on  several  others  in  the  district,  a  dis 
ease  called  '  red  water'  prevailed,  in  some  years  proving  very  fatal ; 
but  after  drainage  and  cultivation  of  the  marshy  parts  of  the  pas 
turage  the  stock  has  been  free  of  that  disease.  The  surface  drain 
age  of  sheepwalks  in  every  district  is  well  known  to  promote  the 
healthiness  of  the  stock,  and  I  believe  the  thorough  drainage  of  a 
single  swamp  in  any  locality  will  be  an  important  means  of  im 
proving  the  health,  both  of  the  population  and  stock  connected 
with  it."1 

In  farther  corroboration  of  this,  it  may  be  remarked  that  it  has 
been  found  in  this  country  that  those  animals  that  feed  in  marshes 
where  periodic  fevers  prevail,  have  diseased  viscera.  We  are  told 
by  Dr.  Ludlow,  that  in  the  town  of  Wolcott,  Seneca  County,  N.  Y., 
where  marshes  and  lowlands  abound,  the  hogs,  when  killed,  are 
generally  found  to  have  eroded  livers.2 

The  history  of  the  Oriental  plague  furnishes  striking  examples 
of  the  influence  of  the  morbid  cause  on  the  lower  order  of  ani 
mals.3  It  has  been  noticed  from  the  earliest  period ;  is  mentioned 
by  poets4  and  historians,5  and  recorded  in  holy  writ.6 

It  is  certain,  also,  "  that  seasons  which  are  unusually  sickly  to 
large  classes  of  human  beings,  are  often  alike  unfriendly  to  the 
health  and  fruitfulness  of  many  classes  of  plants."7  Fodere,  in 
speaking  of  the  Marshes  of  Brcsse,  in  France,  remarks  that  animals 

1  Drainage  of  the  Land  forming  the  Sites  of  Towns,  G9,  70.     London,  1852. 

2  New  York  Med.  and  Phys.  Jo  urn.  ii.  88. 

3  Hippocrates;   Santi  Romeo — Ricerehe  Sulla  Peste  Borbonica;  Diego  Picollo,  de 
scription  de  la  Peste  de   Mission,  chap.  2,  328;  Aubert  and  Etienne,  cited  by  Clot- 
13ey,   2-57 ;   Thos.   Leslie   Greyson,   Rep.   of    Quarantine,    14 ;    Schiller,   257  ;    Short, 
Chron.  Hist,  of  the  Weather  and  Dis.  of  Lond.  338;   Hancock,  101. 

4  Homer,  Iliad,  book  i.  G7,  70;  Lucretius,  lib.  vi.  1117  ;  Ovid,  lib.  vii.  523. 

5  Thu;'ydides,  xi.  52  ;  Livy,  3,  6,  571  ;  Dionysius,  lib.  xx. 

6  Exodus,  vii.  7;   xvii.  18;  viii.  17:  ix.  15. 

7  11'  iiiirt  on  Quarantine  (London).  14;   see  also  Chapman  on  Epid.  Med.  and  Phys. 
Jouru.  vii.  250;  Rush,  50;  Cahhvell,  133;  Coudic  and  Fohvell,  13;  Thouvenel,  200. 


298  PNEUMONIA    AND 

and  plants  are  there  of  a  small  and  feeble  complexion,  stunted  in 
appearance,  and  endowed  with  a  small  degree  of  vital  force;  and 
Boudin,  who  refers  to  this  fact,  states  that  he  has  seen  plants  which 
were  transplanted  in  marshy  localities  deteriorate  rapidly,  and  re 
turn  to  their  normal  state  as  soon  as  they  were  removed  beyond 
reach  of  the  paludal  influence.1 

The  great  diffusion  and  mortality  of  autumnal  fevers  is  explained  only 
on  the  supposition  of  the  cause  being  a  gaseous  poison. — To  no  other  than 
a  truly  toxical  agent,  suspended  in  or  mixed  with  the  atmospheric 
air,  can  we  refer  diseases  which  affect  in  a  similar  way,  and  such 
rapid  succession,  so  large  a  number  of  individuals,  and  occasion 
often  so  extensive  a  mortality.  No  modification  in  the  sensible 
qualities  of  the  air  of  a  given  locality ;  no  atmospheric  vicissitude, 
however  frequent  and  extensive,  has  been  known  to  produce  such 
effects.  A  single  regiment,  in  Africa,  with  an  effective  force  of 
seventeen  hundred  men,  sent,  in  the  short  space  of  six  weeks,  one 
thousand  and  fifty  to  the  hospital,  and  mostly  for  intermittent  and 
remittent  fever.  In  1830,  the  whole  of  another  regiment  was  sent 
to  the  hospital.  In  the  same  year  (1830),  the  number  of  admissions 
in  the  Hospital  of  Buff'arick  amounted  to  2,386;  and  of  these  1,491 
were  affected  with  intermittents.2  According  to  Dr.  Maillot,  22,330 
cases  were  admitted  in  the  Hospital  of  Bone,  from  the  16th  of 
April,  1832,  to  the  16th  of  March,  1835.  Of  these,  2,513  died.3 
So  common  is  ague  in  many  parts  of  Spain  and  Portugal,  says  Sir 
James  Macgrigor,4  "  that  the  inhabitants  do  not  term  it  a  disease." 
Facts  will  bear  Dr.  Williams  out  in  the  remark,  that  the  invasion 
of  the  Burmese  and  of  the  African  empires  has,  in  each  instance, 
been  so  disastrous  to  the  troops,  that  the  whole  force  must  have 
perished  from  this  class  of  diseases,  in  a  few  months,  but  for  the 
success  of  their  arms  in  the  one  instance,  or  their  being  withdrawn 
from  the  pestilent  atmosphere  in  the  other.5  The  British  forces  in 
the  Islands  of  Zealand,  amounted,  on  the  25th  of  August,  1809,  to 
41,642  men,  and  1,879  commissioned  officers.  Between  the  21st  of 
August  and  18th  of  November,  the  number  of  sick,  almost  exclu 
sively  from  fever,  amounted  to  26,846,  including  relapses.6 

1  Fievres  Interm.  108. 

2  Gouraud.  Fiev.  Interm.  2'.»0.  3  Fiev.  Inform.  27<>. 

4  Med.-Chir.  Trans,  vi.  41  o.  5  Morbid  Poisons,  ii.  4">7. 

6  lil:ii)p.  Dissert,  i.  2'2ii,  227 :  sec  also  Marshall,  Edin.  J.  xlviii.  308,  30<». 

The  (]j. sense  betrau  to  show  itself  between  the  loth  and  20th  ol'  August.     OH  the 


AUTUMNAL    FEVERS.  299 

Dr.  Wind,  who  translated  into  Dutch  Dr.  Lind's  essay  on  pre 
serving  the  health  of  seamen,  and  who  practised  medicine  in  Wal- 
cheren  for  many  years,  informs  us  that  the  Scotch  regiment  in  the 
Dutch  service  has  been  known  to  bury  its  whole  numbers  at 
Sluys,  in  Dutch  Flanders,  in  three  years.  We  learn  from  the 
reports  of  Dr.  Borland  and  his  coadjutors  that,  upon  an  examina 
tion  of  the  sick  returns  of  the  French  army  for  a  period  of  seven 
years,  it  was  found  that  at  least  one-third,  or  33  per  cent,  of  its 
force  was  annually  cut  off  by  endemic  diseases.  I  may  add  that, 
when  the  English  landed  in  Walcheren,  there  were  only  eighty-five 
men  alive  in  a  Dutch  regiment,  which,  at  its  arrival  there,  three  years 
before,  was  800  strong.  The  annual  ratio  of  mortality  of  this  corps 
must  have  been  about  31  per  cent.,  or  rather  more  than  double  the 
mean  ratio  of  mortality  which  occurs  among  troops  in  Jamaica. 
Napoleon  seems  to  have  known  pretty  well  the  real  nature  of  the 
climate  of  the  Delta  of  the  Scheldt,  and  of  its  influence  upon 
strangers;  for,  in  a  letter  to  the  Minister  of  War,  in  regard  to  the 
Walchereii  expedition,  he  says :  "  We  are  rejoiced  to  see  that  the 
English  themselves  are  in  the  morasses  of  Zealand.  Let  them  be 
only  kept  in  check,  and  the  bad  air  and  fevers  peculiar  to  the  cli 
mate  will  soon  destroy  their  army."  The  French,  it  is  said,  crowed 
over  the  expedition  with  the  force  of  reason,  the  bitterness  of  sar 
casm,  and  the  playfulness  of  ridicule.1 

Some  fifty  years  before,  Sir  John  Pringle,  in  tracing  the  influence 
of  paludal  exhalations  on  the  British  troops  in  Flanders,  during  the 
campaign  of  1748,  stated  that  they  had  scarcely  been  a  month  in 
the  cantonment,  when  the  return  of  the  sick  amounted  to  2,000. 
One  regiment,  the  Greys,  cantoned  in  Yucht,  a  village  surrounded 
with  meadows,  either  then  under  water  or  but  lately  drained,  were 
the  most  sickly.  At  the  end  of  live  weeks  they  returned  about 
150;  after  two  months,  260,  which  was  one-half  of  their  number; 
and,  at  the  end  of  the  campaign,  they  had  in  all  but  thirty  men 
who  had  never  been  ill.  Another  regiment,  at  Nieuland,  where  the 

29th,  the  number  of  sick  amounted  to  little  less  than  3,000  men.  On  the  30th,  200 
of  the  artillery,  130  of  the  3Gth,  300  of  the  20th,  2-50  of  the  71st,  200  of  the  84th,  and 
the  whole  of  the  23d,  with  the  exception  of  about  forty,  were  in  the  hospitals.  Early 
in  September,  there  Avere  upwards  of  7,000  on  the  sick  list.  On  the  14th,  it  was  esti 
mated  that,  of  15,000  in  Walcheren,  10,000  were  actually  sick.  Of  one  regiment 
alone,  the  38th,  the  sick  return  was  11  officers  and  459  men. — Davis,  A  Scientific  and 
Popular  View  of  the  Fever  of  Walcheren,  9,  12,  14,  &c. 

1  Marshall,  Statistics  of  the  Walcheren  Expedition,  Edin.  J.  xlviii.  313. 


300  PNEUMONIA    AND 

meadows  had  been  floated  all  winter,  and  were  but  just  drained, 
returned  sometimes  above  one-half  of  their  number.  Another, 
again,  the  Scotch  Fusiliers,  at  Dinther,  had  above  three  hundred  ill 
at  one  time.1  The  same  distinguished  writer  informs  us  that  when 
four  battalions  of  British  troops,  which  had  been  employed  in 
Zealand  during  the  year  1747,  went  into  winter-cparters,  their  sick, 
in  proportion  to  the  men  fit  for  duty,  were  nearly  as  four  to  one, 
which  is  equal  to  800  per  1000.2 

At  Fort  Charlotte,  in  the  rear  of  the  town  of  Nassau,  Bahamas, 
nearly  the  whole  of  the  47th  Eegiment,  including  women  and  chil 
dren,  were  swept  off  within  a  short  time.  In  1802,  220  out  of  300 
perished.  Of  seventy  men,  sent  there  in  1818,  forty  died  in  six 
months;  besides  thirteen  women  and  children  out  of  thirty-seven.3 
In  relation  to  the  sickness  in  Jamaica,  Dr.  Hunter  states  that  four 
regiments  were  sent  from  England  in  1780.  They  arrived  on  the 
first  of  August.  Less  than  six  months  after,  one-half  of  them 
nearly  were  dead,  and  a  considerable  part  of  the  remainder  unfit 
for  service.4 

At  the  period  of  the  English  fleet  anchoring  in  the  Rangoon  Eiver, 
on  the  10th  of  May,  the  troops  mustered  between  5,000  and  6,000 
men.  By  the  end  of  June,  fever  had  so  diminished  the  number, 
that,  even  after  reinforcements,  scarcely  3,000  troops  were  left  to 
guard  the  lines.5  Of  the  effects  of  exposure  to  the  African  coast, 
the  results  of  the  Niger  expedition  w^ill  testify.  On  that  occasion 
three  vessels  entered  the  river — the  Albert,  the  Wilberforce,  and 
the  Soudam;  the  first  with  62  white  men  aboard, including  officers; 
the  second  with  56,  and  the  last  with  27.  The  Albert  remained  64 
days  in  the  river ;  the  Wilberforce  45  days,  and  the  Soudam  40. 
In  that  short  space  of  time,  the  number  of  fever  cases  in  the  three 
vessels,  with  a  total  force  of  145  whites,  amounted  to  130,  or  one 
in  1.12 ;  and  that  of  deaths  to  40,  or  one  in  3.6.6 

At  Sierra  Leone,  an  aggregate  strength,  in  eighteen  years,  of 
1,843  white  soldiers  furnished  not  less  than  2,600  cases,  being  in 
the  annual  ratio  of  1.411  per  1,000  of  mean  strength;  while  the 
mortality  amounted  during  that  time  to  410.2  per  1,000.7  In  the 

1  Dis.  of  the  Army,  50,  59.  2  Pringle,  Go,  CO. 

3  Second  Report  on  Quarantine,  50.  4  P.  11.  5  Williams,  ii.  457. 

6  McWillhims,  Mod.  Ace.  of  the  Expedition  of  the  Ni<:er,  120-128. 

7  Tuilock,  Kept,  of  Sickness,  Mortality,  &c.,  among  Troops  on  the  West  Coast  of 
Africa,  8. 


AUTUMNAL    FEVERS.  301 

Cape  Coast  command,  the  aggregate  strength,  in  four  years,  being 
630,  the  number  of  cases  of  remittent  fever  alone  did  not  fall  short 
of  500,  with  an  annual  mortality,  from  the  whole  class,  of  382.6  per 
1,000  of  mean  strength.1  In  a  preceding  part  of  this  volume,  atten 
tion  was  called  to  the  fact  that  in  the  Jamaica  command,  with  an 
aggregate  force,  in  twenty  years  (1817-1836),  of  51,567  men,  the 
number  of  cases  of  malarial  fevers  amounted  to  46,922,  being  in  the 
proportion  of  910  per  1,000  of  the  mean  strength.  In  the  wind 
ward  and  leeward  commands,  an  aggregate  strength  of  86,661  gave, 
during  the  same  period,  no  less  than  62,168  cases,  or  717  per  1,000. 
Honduras,  where  the  aggregate  strength  of  the  white  soldiers,  in 
fifteen  years,  did  not  exceed  320  men,  there  were  221  cases  of  fever, 
or  690.6  per  1,000.2 

A  detachment  of  the  98th  Regiment,  quartered  on  a  height  in 
Happy  Valley  (Hong-Kong,  China),  experienced  a  mortality,  within 
six  months,  amounting  to  25  per  cent.  In  a  locality  called  West 
Point,  at  least  one-half  of  the  whole  force  is  supposed  to  have  been 
lost  by  death  or  invaliding.  In  the  summer  of  18-13,  the  fever  was 
so  fatal,  in  some  parts  of  Hong-Kong,  that  it  cut  off  100  from  a 
total  of  300  civilians  residing  upon  the  island.3 

In  this  city,  during  the  memorable  epidemic  of  1793,  when  the 
population  fell  short  of  50,000,  the  number  of  cases  may  be  esti 
mated  to  have  amounted  to  little  less  than  11,000,  or  200  per  1,000; 
with  a  mortality  of  about  3,500,  or  70  per  1,000  of  the  population. 

New  Orleans,  in  1847,  contained  a  population  estimated  at 
109,000.  Of  these,  20,000,  or  184.31  per  1,000,  suffered  from  the 
yellow  fever.  Two  thousand  eight  hundred  and  eleven  cases  were 
reported,  and  of  these  895  died.  The  population  of  "Woodville 
(Miss.)  amounted,  in  1845,  to  800.  Of  this  number,  595  passed 
through  the  disease  in  one  or  other  of  its  various  forms ;  being  in 
the  proportion  of  74.4  per  cent.  It  is  to  be  borne  in  mind  that  200 
of  the  inhabitants  left  the  village  early,  so  that  disease,  in  fact,  bore 
on  a  population  of  600,  and  therefore  attacked  them  in  the  propor 
tion  of  99.17  per  cent.  The  population  of  Cadiz,  in  1800,  is  stated 
to  have  been  71,491.  Of  these,  48,520  were  attacked  with  the 
reigning  epidemic;  being  in  the  proportion  of  678.7  per  1,000.  In 

1  ibid.  20. 

2  Ib.  Sickness  and  Mortality  of  Troops  in  West  Indies,  7,  44,  45,  77. 

3  Bnrton,  Fever  of  Hong-Kong,  Dublin  J.  No.  24,  p.  440,  441,  N.  S. 


302  PNEUMONIA    AND 

1819,  the  results  were  scarcely  different.  In  Seville,  in  1800,  the 
proportion  was  larger  still;  the  population  being  80,568,  the 
number  of  cases  76,488,  or  919.4:  per  1,000,  and  the  deaths  11,685. 
In  Alicant,  in  1801,  out  of  a  population  of  13,000,  9,000,  or  692.4 
per  1,000  had  the  disease,  and  2,172  died.1  As  I  am  writing  these 
lines  (November  21),  the  melancholy  accounts  received  from  New 
Orleans,  exhibit  a  mortality  there,  this  year,  from  yellow  fever,  of 
40  in  June,  1,406  in  July,  5,189  in  August,  1,070  in  September, 
and  139  from  the  1st  to  the  22d  of  October,  making  a  total,  with 
three  in  May,  of  7,847. 

During  an  epidemic  of  pernicious  or  malignant  intermittent  fever, 
which  occurred  in  Bordeaux  in  1805,  and  is  ably  described  by  Dr. 
Contanceaux,  it  is  estimated  that  twelve  thousand  individuals 
passed  through  the  disease,  and  that  one-fourth  of  these  died.2 
The  fever  which  swept  over  the  Coromandel  in  1809,  1810,  and 
1811,  caused  the  loss  of  106,789  out  of  a  population  of  1,828,610. 
Coimbatore  lost  in  sixteen  months  22,451  out  of  596,606;  Madura, 
in  twelve  months,  lost  24,626  out  of  245,654;  Dendigul,  in  the 
same  space  of  time,  had  21,510  deaths  in  29,654  individuals:  while 
at  Tinnivelly,  the  mortality,  in  the  short  space  of  five  months, 
exceeded  38,000  in  a  population  of  690,696.3 

"It  is  remarkable,"  says  Lind,  "that,  in  the  war  which  terminated 
in.  1763,  the  English  ships  of  war  which  touched  at  Batavia,  suffered 
more  by  the  disease  of  that  climate,  than  they  did  in  any  other  part 
of  India,  if  we  except  a  malignant  scurvy  which  once  raged  in  the 
fleet  at  sea.  Soon  after  the  capture  of  Manilla,  the  Falmouth,  a  ship 
of  fifty  guns,  went  to  Batavia,  where  she  remained  from  the  latter 
end  of  July  to  the  latter  end  of  January,  during  which  time  she  buried 
seventy-five  of  her  crew  and  one  hundred  soldiers  of  the  70th  Regi 
ment,  who  were  embarked  on  board  of  her,  not  one  person  in  the 
ship  having  escaped  a  fit  of  sickness,  except  her  commander,  Captain 
Brereton.  The  Panther,  a  ship  of  sixty  guns,  was  there  in  the  years 
1762  and  1764,  both  times,  unhappily,  during  the  rainy  season.  In 
the  year  1762,  she  buried  seventy  of  her  men,  and  had  ninety-two 
very  ill  Avhen  she  left  the  place.  In  the  year  1764,  during  a  short 

1  Sec  an  Essay  on  the  Mortality  of  Yellow  Fever,  by  the  present  writer,  Charleston 
Mod.  J.  vii.  403. 

2  Notice  sur  les  Fievres  Pernicieuses  qui  ont  regn6  a  Bordeaux,  en  1 805. 

3  Mod.,  Geog.,  and  Agricult.  Hep.  on  Fever  of  Coimbatore,  £c.,  by  Ainslie,  Smith, 
and  Christy,  Lond.  1810,  p.  98,  &c. 


AUTUMNAL   FEVERS.  303 

stay,  she  buried  twenty-five  of  her  men.  The  Medway,  which  was 
there  in  company  with  her,  lost  also  a  great  number  of  her  men." 
The  fever  was  of  the  remitting  kind.1 

In  addition  to  the  facts  already  adduced,  the  attention  of  the 
reader  might  be  called  to  the  wide  diffusion  and  excessive  mortality 
noted  during  some  epidemics  of  glandular  plague.  lie  might  be 
reminded  that,  in  London,  in  1625,  it  carried  off  not  less  than 
35,417  individuals,  according  to  Grant,2  and  46,000,  according  to 
the  calculation  of  Short  ;3  that,  in  the  same  city,  the  mortality,  forty 
years  after  (1665^,  amounted  to  97,000,4  in  a  population  of  less  than 
500,000;  that,  in  1812,  the  loss  at  Constantinople  amounted  to 
159, 534  ;5  and  that  in  Lyons,  in  1628,  29,  in  a  population  of  some 
200,000  ;6  fifty  thousand  persons  were  destroyed  by  the  same  disease. 
They  might  also  be  told  that,  at  Montpellier,  the  number  of  deaths 
in  1629  fell  but  little  short  of  one-half  of  the  inhabitants  who  had 
not  left  the  city;7  that,  in  Marseilles,  the  loss  from  the  memorable 
pestilence  of  1720,  amounted  to  forty  thousand  ;8  that  at  2s~oja,  in 
1815-16,  the  number  of  cases  in  a  population  of  5,300  reached 
1,474,  and  the  deaths  716  ;9  that  at  Cyprus,  in  1760,  the  disease  de 
stroyed  70,000,  out  of  a  population  of  600,000  ;10  again,  that  at 
Aleppo,  the  population  of  which  amounted  to  some  60,000,  it  car 
ried  off' in  two  years  (1761,  62)about  21,800,n  and  that,  in  1835,  the 
loss  in  Cairo  was  little  short  of  26,000."12  These  and  other  instances 
of  like  import,  might  be  specially  adduced  for  the  object  under 
present  consideration ;  but  as  the  question  of  the  malarial  origin 
of  the  Oriental  plague  continues  to  this  day  to  be  a  subject  of 

1  Hot  Climates,  102,  103.     Chisliolm  states  that,  in  the  year  1795,  the  Majestic,  74. 
Admiral  Sir  John  Latbrey's  ship,  while  shut  up,  during  the  hurricane  months,  within 
a  little  landlocked  bay,  situate  in  the  great  bay  of  Fort  Royal,  Martinico,  called  Les 
Irois  ihts  benits,  and  not  inappropriately  named,  by  the  French,  Goujfre  de  la  Mort,  lost 
in  seven  weeks  one  hundred  and  eighty-nine  men.     During  the  same  months  of  1796, 
Admiral  Harvey's  ship,  the  Prince  of  Wales,  lay  at  the  same  place,  and  lost  ninety- 
seven  men.     (Manual  of  the  Climate,  &c.  of  Tropical  Countries,  20.) 

2  Natural  and  Political  Observations,  &c.  made  upon  the  Bills  of  Mortality,  8. 

3  New  Obs.  on  Bills  of  Mortality,  274. 

4  Short,  op.  cit.  292 ;  Marshall,  Stat.  and  Mortality  of  the  Metropolis,  GO. 

5  Braver,  Neuf.  Annees  a  Constantinople,  ii.  248. 

6  Papon,  De  la  Peste,  Ou  les  Epoques  Memorables  de  ce  Fleau,  i.  184. 

7  II.  195.  s  Ib.  343. 
9  Moreo,  Storia  della  Peste  de  Noja,  25  ;   Tavola,  3. 

w  Russell  on  the  Plague,  8.  »  Ib. 

12  Boudin  (from  Gaetani  Bey),  Geogr.  Med.  14. 


304  PNEUMONIA    AND 

doubt  amon0"  those  most  conversant  with  the  disease,  I  shall  not 

o  ' 

insist  upon  them  here. 

Let  this  be,  however,  as  it  may,  the  facts  already  mentioned,  no 
less  than  the  circumstance  that,  in  times  of  violent  epidemics,  the 
early  cases,  very  generally,  prove  fatal,  are  with  difficulty  explained 
on  the  supposition  of  those  diseases  resulting  from  the  action  of 
any  other  cause  than  a  morbid  poison  diffused  in  the  atmosphere  of 
infected  localities.  Under  no  circumstances  have  diseases,  undeni 
ably  produced  by  mere  changes  in  the  sensible  qualities  of  the  air, 
been  found  to  spread  so  widely,  to  occasion  so  extensive  a  mor 
tality,  and  to  assume  so  usually  a  more  malignant  and  fatal  charac 
ter  at  the  outset  of  their  prevalence. 

Autumnal  fevers  under  the  influence  of  various  exciting  causes. — In 
dividuals  exposed  to  the  atmosphere  of  paludal  localities  in  sickly 
seasons,  or  residing  in  cities  visited  by  malignant  and  other  fevers, 
become  affected  with  the  disease  therein  prevailing  from  the  opera 
tion  of  a  variety  of  exciting  causes.  Insolation,  exposure  to  rain, 
or  to  a  current  of  cold  air,  a  fit  of  intemperance,  or  the  free  use  of 
stimulating  drinks,  excessive  fatigue,  irregularity  of  diet,  a  blow, 
a  fall,  a  surgical  operation,  the  loss  of  blood,  a  moral  affection,  an 
inter  current  complaint,  £c.  &c.  will  bring  on  an  attack  of  the  pre 
vailing  fever.  It  cannot  be  presumed  that  all  these  morbid  influ 
ences,  differing  as  they  do  so  materially  from  each  other,  are  capa 
ble  of  producing,  unaided  by  some  more  efficient  and  special  cause, 
one  and  the  same  disease.  Hence,  their  agency  must  be  limited  to 
the  placing  suddenly  the  system,  by  the  disturbance  or  shock  they 
therein  occasion,  in  a  condition  required  to  enable  it  to  be  mor 
bidly  affected  by  a  cause  of  a  more  general  character,  producing  an 
impression  on  all  exposed  to  it,  and  occasioning,  when  it  meets  sub 
jects  suitably  predisposed,  a  particular  and  specific  set  of  morbid 
phenomena  similar  in  all  that  are  attacked.  We  know  of  no  dis 
eases,  except  those  owing  their  origin  to  the  action  of  morbid  poi 
sons,  that  can  thus  be  brought  out  by  perturbating  agencies  of  the 
kind  mentioned;  and  the  fact  of  the  circumstance  being  observed  in 
regard  to  intermittent  and  other  fevers  of  like  nature,  lends  a  strong- 
support  to  the  opinion  that  the  cause  which  gives  rise  to  them 
consists  in  a  poison  of  the  sort  floating  in  the  air  of  the  sickly 
locality. 


AUTUMNAL    FEVEKS.  305 

The  malarial  origin  of  such  fevers  confirmed  by  tJie  violent  manner 
the  cause  often,  acts. — I  might  enlarge,  in  addition,  on  the  circum 
stance  that  the  efficient  cause  of  fever  approximates  in  nature  to  all 
morbid  poisons  by  the  suddenly  violent  and  disorganizing  effects  it 
produces  in  the  system;  for  though,  when  applied  in  a  lesser  force 
and  in  a  gradual  manner,  it  will  give  rise,  as  we  have  seen,  to 
derangements  of  the  viscera,  and  consequent  ill  health,  without, 
however,  exciting  the  usual  symptoms  of  marked  febrile  affections; 
though,  in  other  instances,  the  application  of  the  cause  occasions 
fevers  of  a  comparatively  mild  character,  running  their  course  in 
a  few  days,  yet  in  some  instances  death  rapidly  or  even  suddenly 
follows  exposure  to  sources  of  infection ;  so  rapidly,  indeed,  that 
dissection  reveals  no  traces  of  structural  lesion.  In  all  epidemics 
of  yellow  fever,  while  the  duration  of  the  disease  extends  generally 
to  the  third,  fifth,  or  seventh  days,  and  in  some  few  instances  much 
beyond,  cases  occur1  in  which  it  closes  fatally  in  twenty -four,  or 
even  in  a  very  few  hours,  without  leaving  any  posthumous  sign  of 
local  determination.  Results  not  very  different  are  observed  in 
that  form  of  malarial  disease  which  has  received  the  name  of  con 
gestive  fever  as  well  as  in  malignant  or  pernicious  intermittents. 
The  system,  in  such  cases,  is  at  once  prostrated,  and  the  patient 
sinks  without  having  manifested  the  least  sign  of  a  healthful  reac 
tion.  In  no  diseases,  but  those  originating  from  the  action  of  mor 
bid  poisons,  do  we  meet  with  occurrences  of  the  kind. 

The  cause  of  fever  extends  its  action  to  the  foetus  in  utero. — I  might 
also  refer  as  illustrative  of  the  true  toxical  character  of  the  efficient 
cause  of  fevers — of  its  analogy  to  other  morbid  poisons,  and  to 
the  fact  of  its  producing,  like  these,  its  deleterious  impression 
through  the  blood,  and  consequently  of  its  power  of  solution :  that 
it  is  known  to  affect  the  foetus  in  utero,  and  the  infant  at  the  breast. 
Need  I  remark,  that  cases  are  on  record  to  show  that  the  smallpox 
has  been  transmitted  from  the  mother  to  her  unborn  offspring ; — 
children  coining  into  the  world  with  well-characterized  pustules 

1  Hush,  iv.  13:  Dcve'/.c,  28;  Cakhvell,  85-87;  Lining,  ii.  426;  Manson.  181; 
Baxter,  llepos.  xxi.  3;  Grus.  13;  Dickson,  Chapman,  J.  iii.  256;  Thomas,  8!) ;  Ber- 
thc,  70  ;  Arejula,  10]  ;  Jackson,  Fever  of  Spain,  45  ;  Pym,  60  ;  Palloni,  G  ;  Kochoux, 
510,  508;  Warren,  Fever  of  Barbadoes,  10;  Gilbert,  CO,  73;  Bally,  272;  Caillot, 
22,  23;  CliKsholm,  i.  104;  Aloseley,  440:  Imray,  Ed.  J.  liii.  82;  Bancroft,  35;  Wil 
son.  7. 

20 


306  PNEUMONIA    AND 

over  the  surface  of  the  body?  If  the  reader  doubts  it,  let  him  open 
the  works  of  Jenner,  Gregory,1  Andry,2  Gardien,3  Desormeau,4 
Mauriceau,5  Dimdale,0  and  other  writers  of  easy  access,  and  he  will 
find  instances  of  this  transmission  stated  by  high  and  reliable 
authorities.  He  will  find  that  Mauriceau,  whose  celebrity  as  an 
obstetrician  is  known  to  all,  was  himself  born  bearing  the  charac 
teristic  marks  of  that  disease.  He  will  find,  besides,  that  cases  are 
recorded  in  which  those  well-known  marks  were  found  on  infants 
whose  mothers  were  not  affected.7  He  will  even  find — but  for 
the  authenticity  of  the  fact  I  will  not  hold  myself  responsible— 
that  a  Swedish  woman  having  been  vaccinated  nine  days  before 
her  accouchement,  the  child,  at  its  birth,  bore  on  the  arms,  and  on 
the  same  spots  as  the  mother,  regular  vaccine  pustules.8  Extending 
his  inquiries  to  other  complaints,  he  will  find  that  measles,  scarla 
tina,  syphilis,9  and  pellagra10  are  reported  to  have  been  thus  trans 
mitted.  While  such  is  the  case  with  these  diseases,  we  have  the 
testimony  of  Kussell,  and  others,  to  the  effect  that  a  similar  occur 
rence  has  sometimes  taken  place  in  relation  to  tertian  and  other 
malarial  fevers.  By  more  than  one  author  cases  are  mentioned— 
and  one  of  the  kind  fell  under  the  notice  of  the  present  writer, 
in  which  some  of  the  symptoms  of  yellow  fever  were  transmitted 
in  this  way,  from  the  mother  to  the  unborn  babe. 

Dr.  Ludlow,  in  his  observations  on  the  lake  fevers  in  the  Genesee 
country,11  relates  the  following  case : — 

"  Mrs.  K.  had  fever  and  ague  at  two  different  times.  During  the 
last  stage  of  her  last  pregnancy  intermittents  were  very  prevalent. 
Having  for  several  days  suffered  some  of  the  precursory  symptoms, 
she  was,  on  Sunday  afternoon,  attacked  with  a  severe  paroxysm. 
Every  stage  of  it  was  regular  and  distinct,  the  paroxysm  terminating 
in  diaphoresis.  On  Monday  morning  she  was  delivered  of  a  boy, 
apparently  at  the  full  time.  On  Monday  afternoon,  at  about  the 

1  Cyclop,  of  Pract.  Med.  iii. 

2  Maladies  du  Foetus,  Journal  des  Progress  des  Sc.  Med.  N.  S.  i.  142. 

3  Traite  des  Accouchemens,  352.  4  Diet,  de  Med.  xv. 

5  Obscrv.  sur  la  Grossesse,  &c.  ii.  493;  Obs.  D.  C. 

6  Treatise  on  Smallpox,  279. 

7  Bousquet,  Traite  de  la  Vaccine,  107;   Fodere,  Med.  Legale,  v.  397;  Jenuer,  Jour 
nal  des  Progres,  i.  142-6;   Deneux,  cited  by  Anglada,  Traite  de  la  Contagion,  i.  81. 

8  Journal  des  Progres,  xv.  246.  9  Journal  des  Progres,  i.  X.  8.   I  42,  170. 
10  Roussel,  Traite  de  la  Pellagre.               n  New  York  Med.  and  Pliys.  J.  ii.  94,  95. 


AUTUMNAL    FEVERS.  307 

same  time  of  day  at  which  the  Sunday's  paroxysm  had  occurred, 
the  child  was  attacked;  the  cold  stage  was  severe  and  long;  the 
skin  being  livid,  and  the  child  was  thought  to  be  dying.  This  was 
followed  by  the  hot  stage,  and,  in  due  time,  by  diaphoresis.  The 
paroxysms  continued  to  recur  daily  for  about  a  fortnight,  when 
small  doses  of  Peruvian  bark  were  given.  The  disease  soon  ceased; 
but,  in  about  a  week,  the  child  had  two  fits  more,  when  the  bark 
again  arrested  it.  The  child  is  now  more  than  two  years  old,  is  fat 
and  healthy,  arid  has  had  no  more  attacks  of  the  fever.  The  disease 
did  not  recur  in  the  mother  after  delivery.  Both  still  reside  in  the 
same  house,  which  is  on  aguish  ground." 

Dr.  Ludlow  properly  remarks,  that  this  case — -as  others  he  re 
lates — very  satisfactorily  proves  that  the  disease  is  sometimes  con 
genital.  It  is  "  remarkable  for  the  regular  transfer  of  the  disease 
from  the  mother  (in  whom  the  susceptibility  had  been  worn  out) 
to  the  child,  who,  like  others  who  had  never  had  the  disease,  was 
perfectly  susceptible  of  it."  The  child  was  affected  too  soon  after 
birth  to  justify  our  believing  he  did  not  carry  in  him  the  seeds  of 
the  disease.  Dr.  Stokes  relates  the  case  of  a  woman,  pregnant  and 
labouring  under  tertian  fever,  who  felt  the  child  to  have  convulsive 
fits  on  days  of  pyrexia. 

Bond  in,  to  whom  reference  has  so  often  been  made,  states  that 
he  has  several  times  had  occasion  to  notice  the  transmission  of  the 
disease  in  question,  from -nurses  to  infants  at  the  breast,  as  manifested 
by  paroxysms  of  fever,  and  other  limnhenic  symptoms.  "  In  proof," 
he  adds :  "  I  will  add  that  the  infants  in  question  were  not  under 
the  influence  of  a  primitive  intoxication,  caught  by  them  in  a  focus 
of  paludal  exhalation,  and  that  my  observations  were  made  at  the 
Lazaretto  of  Marseilles,  where  malarial  fevers,  unless  imported,  are 
never  encountered.  Doubtless  the  most  curious  fact  of  transmis 
sion  I  have  met  with,  is  the  following:  The  wife  of  a  soldier, 
recently  arrived  from  Africa,  and  enjoying  good  health,  undertook 
to  nurse  the  child  of  an  inhabitant  of  Toulon.  On  the  third  day, 
the  child  was  attacked  with  a  malarial  fever,  which  was  only  cured 
by  the  sulphate  of  quinia."1  In  this  respect,  paludal  fevers  are  on 
a  footing  with  syphilis,  the  mercurial  disease,  &c.,  all  of  which  are 
transmissible  from  a  healthy  nurse  to  the  infant  at  the  breast. 
That  typhoid  fever  has  been  found  to  be  so  conveyed,  is  proved 

1  Fievre  Interm.  103,  194. 


308  PNEUMONIA    AND 

by  the  ulcerations  discovered  in  the  intestines  of  the  child.1     The 
same  has  been  reported  in  reference  to  dysentery.2 

The  cause  of  autumnal  fever  appears  to  lie  neutralized  by  the  poison 
of  some  zymotic  diseases  which  have  no  effect  on  common  complaints. — 
Attention  might  be  called  also  to  and  much  said  on  the  fact 
observed  in  Sweden  and  other  parts  of  Europe,3  that  intermittent 
fevers  disappeared  for  several  years,  after  the  great  epidemic  of 
cholera,  from  their  usual  habitats ;  that  the  observation  was  made 
not  only  in  places  that  had  been  visited  by  cholera,  but  likewise  in 
localities  where  that  disease  had  never  appeared ;  and  that,  after  the 
decline  of  the  former,  fevers  again  made  their  appearance,  but  in  a 
less  malignant  form — facts  which  cannot  be  readily  explained,  ex 
cept  on  the  supposition  of  the  cause  of  fevers  being  of  the  nature 
contended  for,  and  of  its  being  destroyed  or  neutralized  by  the  one 
giving  rise  to  cholera. 

It  is  also  to  be  borne  in  mind,  that  mephitic  exhalations  would 
appear  to  have  the  power  of  imparting  protection  to  those  accus 
tomed  to  them  against  malarial  diseases,  as  also  against  those  arising 
from  peculiar  meteorations.  It  was  remarked  at  Paris,  that  indi 
viduals  employed  or  living  in  the  immediate  vicinity  of  the  exten 
sive  knackery  of  Monfaucon,  did  not  suffer,  to  any  serious  extent, 
from  the  cholera,  which  almost  decimated  the  other  districts  of  that 
city.  In  some  parts  of  England,  the  men  whose  business  it  was 
to  attend  to  the  drains  were  in  like  manner  almost  entirely  exempt 
from  that  disease.4  Kaymond,  nearly  a  century  ago,  had  made 
similar  observations  in  regard  to  other  zymotic  complaints.  "  I  no 
tice,"  he  says,  "that  workmen  employed  at  inferior  (sordides) trades, 
and  in  factories  filled  with  vapours,  such  as  starch-makers,  tanners, 
buckskin-makers,  &c.,  are  less  subject  to  popular  diseases.  This 
observation  reminds  us  of  one  recorded  by  Cole  de  Ballon  a,  that 
during  the  fatal  plague  of  the  year  1348,  individuals  working  at 
filthy  trades  escaped  the  contagion."5  The  reader  cannot  have  for 
gotten  that  during  the  fatal  epidemic  of  yellow  fever  which  visited 
the  city  of  Philadelphia,  in  1793,  it  was  observed  by  Dr.  Rush,6  that 

1  Boudin,  190;  Roederer  and  Wagler,  163. 

2  Zimmerman,  Traite  de  la  Dys.  28;  ,T.  Frank,  Prax.  Med. ;  Watson,  440. 

3  British  and  Foreign  Med.-Chir.  Rev.  x.  375. 

4  First  Report  of  Commissioners  on  the  State  of  Large  Towns,  100,  104. 

5  Mem.  de  la  Soc.  Roy.  de  Med.  iv.  77.  6  Works,  iii.  83. 


AUTUMNAL    FEVERS.  309 

the  scavengers  suffered  much  less  than  others  differently  employed. 
Similar  statements  are  made  by  Caillot.1  Ambrose  Pare  remarks 
that  during  the  epidemic  fever  which  prevailed  at  Paris  in  1565, 
tanners  and  curriers  were  in  great  measure  exempt.  It  may  be 
remarked  in  addition  that  at  Eome  the  section  appropriated  to  the 
Jews,  the  Ghetto — where  the  precepts  of  public  hygiene  are  sadly 
neglected,  and  where  of  course  filth  abounds — is  not  entirely  but 
comparatively  free  from  the  periodic  fevers  which  afflict  severely 
other  and  cleaner  parts  of  the  city.2 

It  is  from  a  consideration  of  these  facts,  and  from  having  observed 
that  in  some  localities  in  Mexico  and  other  parts  of  America,  indi 
viduals  inhabiting  filthy  districts  suffer  less  from  yellow  fever  than 
those  who  live  in  cleanlier  ones,  that  a  physician  of  our  country 
maintained  that  what  have  heretofore  been  regarded  as  sources  of 
infection  are,  on  the  contrary,  conducive  to  health.  Without  stop 
ping  to  inquire  whether  the  exemption  alluded  to  is  not  the  effect 
of  acclimatization  or  habit  on  the  part  of  those  who  are  supposed 
to  have  reaped  advantage  from  the  nastiness  in  question;  and, 
without  arguing  the  point,  whether  it  would  be  beneficial  or  safe 
to  allow  such  filth  to  remain  undisturbed  with  a  view  to  counteract 
the  baneful  effect  of  the  febrile  poison,  I  may  remark  that  the 
theory,  and  the  practice  founded  upon  it,  are  not  new,  as  may  be  seen 
in  the  following  passage  I  transcribe  from  Lancisi  :3  "  Some  have 
entertained  a  notion  that  the  effluvia  of  corrupted  substances  and 
marshy  waters  had  no  manner  of  noxious  operation,  because  they 
have  read  that  these  very  agents  were  sometimes  considered  as 
remedies  in  some  pestilential  seasons.  Thus,  Alexander  Benedictus 
relates  that  he  had  heard  from  a  merchant  of  Candia,  that  all  the 
dogs  were  killed  during  the  prevalence  of  a  violent  plague,  and  by 
order  of  the  physicians  thrown  about  the  streets.  The  air  was  soon 
filled  with  their  corrupting  exhalations,  and  their  remedial  operation 
immediately  restored  the  place  to  health.  The  Sarmatians  were  ac 
customed  to  employ  the  same  means.  Yery  near  akin  to  this  story 
is  another,  related  by  George  Pictorius,  who  heard  a  man  from 
Utopia  (!)  affirm  that,  in  an  epidemic  plague,  nothing  was  more 
wholesome  and  excellent  than,  three  times  a  day,  to  snuff  up  the 

1  Op.  dt.  123. 

2  Tournon,   Etudes  sur  Rome,  ii.  ;   Carriere,  Le   Cliinat  de  1'Italie,  373;  Valentin, 
Voy.  Med.  en  Italic,  100. 

3  Do  Xox  Palud.  Effl.  lib.  i.  cap.  iv.  11,  12. 


310  PNEUMONIA    AND 

fumes  of  a  privy  or  of  a  sheepfold.  So,  also,  Joseph.  Quercetarms 
adduces  the  case,  so  familiar  to  the  people  of  Paris,  to  wit,  that  of 
the  nastiness  of  their  streets  being  considered  by  many  physicians 
as  checking  the  putrefactive  taint  of  their  atmosphere.  Nor  are 
there  wanting  other  authorities  from  very  serious  writers,  collected 
by  Gaspar  a  Kejcs,  by  which  it  is  shown  that  bad  smells  are  some 
times  valuable  auxiliaries  of  nature." 

It  is  but  justice  to  Lancisi  to  remark,  that  he  attached  no  faith 
to  the  theory  thus  set  forth,  or  to  the  advantages  of  the  practice 
suggested,  and  seems  disposed  to  unite  in  opinion  with  Kejes,  who 
rejects  the  practice,  and  says  that  the  experiments  and  their  authors 
ought  to  be  banished  to  those  barbarous  places  where  the  former 
were  made. 

Cause  of  autumnal  fever  antagonistic  to  that  of  some  other  diseases. — 
Xor  is  this  the  only  instance  of  antagonism  that  may  be  referred  to 
in  illustration  of  the  toxicological  nature  of  the  cause  of  malarial 
fevers.  That  of  phthisis  with,  such  fevers,  in  virtue  of  which  one 
of  these  diseases  is  stated  to  exclude  the  other,  might,  if  founded 
in  fact,  be  usefully  adduced ;  for  such  an  antagonism  could  not  be 
explained  otherwise  than  on  the  supposition  of  the  cause  of  fever 
consisting  of  something  different  from  a  mere  modification  in  the 
sensible  qualities  of  the  air — of  something  specifically  different  from 
the  ordinary  causes  of  disease,  and  of  the  tubercular  virus  in  par 
ticular,  and  capable  of  neutralizing  the  latter,  or  of  producing  a 
diseased  condition  of  solids  and  fluids,  which  exercises-  a  counter 
acting  influence.  Originally  suggested  in  Italy,  in  the  early  part 
of  the  last  century,  by  Lancisi,  wiio  found,  or  thought  he  had  found, 
that  "  marshes  are  salutary  to  men  of  certain  temperaments,  such, 
for  example,  as  are  full  of  acrid  salts,  prone  to  coughing,  or  slender 
frames,  and  predisposed  to  consumption,'"  the  belief  in  this  patho 
genic  antagonism  was  subsequently  advocated,  in  1783,  by  Dr. 
Bang,2  of  Copenhagen,  and  in  1784,  by  Dr.  Marx,  in  a  treatise  on 
consumption.  Taken  up  anew  in  England,  more  than  half  a  century 
ago,  by  Dr.  Harrison,  of  Ilorncastle,  Lincolnshire,3  and  ton  years 
after  him,  by  Dr.  Wells,  of  London,4  it  has  been  revived  recently 

1   Op.  cit.  lib.  i.  cap.  v.  10.  2  Scbata  Diarii  Xo.socomii  Fredericiana,  i.  1-3. 

3  London  Med.  and  1'liys.  J.  viii.  221,  Lond.  1802. 

4  Trans,  of  a  Soc.  for  the  Improvement  of  Mcd.  and  Cbirurg.  Knowledge,  iii.  -171, 
Lond.  1812. 


AUTUMNAL   FEVERS.  311 

by  Dr.  Boudin,1  and  by  him  sustained  with  considerable  ability  and 
much  research,  but  with  an  evident  pretension  to  originality  well 
calculated  to  elicit  a  smile  from  his  English  and  American  readers. 
But  although  this  antagonism  has  won  the  admiration  of  this  able 
writer,  and  is  well  thought  of  by  some  of  his  countrymen,  and  a 
few  physicians  elsewhere  ;2  although  it  be  true  that  phthisical 
patients  are  frequently  benefited  by  a  residence  in  malarial  locali 
ties;  that  such  localities  are  noted  for  the  rarity  or  absence  of 
phthisis ;  that  those  in  which  the  latter  disease  prevails  are  free 
from  periodic  fevers ;  that  these  diseases  have  been  found  to  replace 
each  other  in  the  same  locality;  and  that  phthisis  is  becoming  com 
mon  where  the  country,  in  consequence  of  the  draining  of  marshes, 
is  freed  from  febrile  paludal  diseases ;  and  although,  besides,  the 
power  in  question  is  in  some  measure  explained  and  sustained 
by  the  circumstance  pointed  out  by  Rokitansky,  that  an  unusual 
venosity  of  the  blood — a  condition  observed  in  malarial  fever — 
proves  an  obstacle  to  the  formation  of  tubercles ;  still,  the  theory 
has  not  yet  been  satisfactorily  established.  So  far,  indeed,  from  its 
being  true  that  one  of  these  diseases  excludes  the  other,  facts  may 
easily  be  found  to  show  that,  in  many  regions  of  country  where 
intermittents  and  remittents  are  common,  phthisis  is  as  frequently 
encountered  as  in  non-malarial  districts  of  neighbouring  or  distant 
latitudes ;  while  there  are  many  reasons  to  believe  that  the  absence 
of  phthisis,  and  its  mitigation  in  some  paludal  districts,  is  attributa 
ble  to  the  peculiarity  of  climate,  growing  out  of  the  thermometrical 
and  hygrometrical  conditions  of  the  atmosphere,  rather  than  to  any 
direct  and  antagonistic  agency  of  the  malarial  poison  there  evolved.3 

1  De  1' Influence  des  localites  Marecageuses  sur  le  frequence  et  la  march e  de  la  Pht. 
Pulm.  et  de  la  F.  typhoide  An.  d'llyg.  xxxiii.  58,  and  republished  under  the  title  of 
Etudes  de  Geologic  Med.   sur  la  Phthisis  P.,  Paris,  1845;   ibid.  Tr.  des  F.  Int.  and 
Remit,  1842,  p.  72 ;   ibid.  Essai  de  Geogr.  Med.  42,  &c. 

2  Tribe,  De  1'heureux  Influence  des  localites  Marecageuses  sur  la  tubei'culisation 
pulmonaire,  Montpellier,   1843;   Green,  New  York  Journ.  of  Med.   and  Surg.  1840; 
Henuen,  Topography  of  the  Mediterranean,  223;  Carriere,  Du  Climat  de  Tltalie,  336; 
Heulard,  Mem.  de  1'Acad.  dc  Med.  xiv.  129  ;  bulletin  de  1'Acad.  de  Med.  vii.  213,  305, 
via.  931  ;  llaspel,  Maladies  de  1' Algeria,  ii.  423  ;   Giannini,  Delia  Natura  delle  Febbri, 
i.  115,  and  i.  237  of  translation;   King,  Southern  Journ.   of  Med.   and  Surg.   Sci.  i. 
167;   Pritchett,   African  Hem.    Fever,   125  (note);   Scheenlein,    Klinische   Vortraege, 
Berlin,  1842;  Wilson,  Stat.  Reports  of  the  Health  of  the  Navy  (British)  S.  Am.  111. 

3  Lefevrc,  Bulletin  de  1'Acad.  x.  1041  ;   Southey,  Observations  on  Pulmonary  Con 
sumption,  Loud.  1814;  Forry,  Climate  of  U.  S.  205,  2GG ;  Sir  J.  Clark  on  the  Sanative 
Influence  of  Climate,  GO,  3d  ed. ;  An.  d'Hyg.  xxxvi.  8,  12;   Grant,  Sanitary  Condition 


312  PNEUMONIA    AND 

Dr.  Lawson,  in  an  instructive  essay  on  the  effects  of  climate  in 
the  production  of  diseases  of  the  lungs,1  states,  after  a  thorough 
examination  of  the  subject,  that  the  mortality  of  tuberculous  affec 
tions  of  the  lungs  among  the  English  troops,  in  the  various  mala 
rious  localities  they  occupy,  completely  accords  with  the  opinion 
of  Sir  James  Clark  and  Dr.  Forry;  for,  although  the  absolute  num 
ber  of  deaths  from  these  diseases  may,  in  the  malarious  situations, 
be  less  than  in  a  more  healthy  one,  still,  they  will  always  be  more 
numerous,  relatively  to  those  from  the  purely  inflammator}7-  diseases 
of  the  lungs,  than  in  the  more  healthy  locality.  It  is  not  sure, 
indeed,  that,  instead  of  diminishing  the  tendency  to  consumption, 
malaria  will  not  increase  it ;  for  it  seems,  as  we  all  know,  to  destroy 
the  balance  of  the  functions,  and  lessen  the  tone  of  the  system,  and, 
by  defibrinating  the  blood,  deprives  the  body  of  the  proper  nutri 
tion  by  which  the  organic  functions  are  sustained — circumstances 
which  all  tend  to  produce  or  arouse  the  tubercular  diathesis. 

More  plausible  in  many  respects — better  sustained,  indeed,  by 
facts,  and  explainable  only  by  the  neutralizing  or  antidotal  effects 
of  different  poisons — is  the  theory  of  a  pathogenic  antagonism 
existing  between  the  cause  of  malarial  diseases,  properly  so  called, 
and  that  of  typhoid  fever,  by  virtue  of  which  the  latter  fever  seldom 
if  ever  prevails  in  paludal  localities  where  periodic  fever  abounds, 
and  vice  versa;  and  in  the  same  locality,  at  different  periods,  and 
under  particular  conditions  of  soil.  Whether  the  history  of  these 
two  forms  of  febrile  complaints,  in  all  regions  they  visit,  Avill  bear 
out  the  advocates  of  this  antagonism  to  the  full  extent  of  their  con 
clusions,  is  more  than  can  be  now  positively  averred.  Judging, 
however,  from  the  many  facts  collected  by  M.  Boudin,2  who  de 
serves  more  credit  on  the  score  of  originality,  in  relation  to  this 
point,  than  to  that  of  the  antagonism  of  phthisis  •with  malarial 
fevers,  and  from  others  gathered  in  this  country  and  elsewhere,  it 
is  impossible  to  withhold  the  expression  of  the  opinion  that  the 
theory  he  has  suggested  is  entitled  to  a  respectful  consideration. 
In  the  malarial  districts  of  France,  Germany,  Spain,  Algiers,  Bone, 
Senegal,  India,  and  Greece;  in  the  Morea,  and  the  Walchcrcn, 
typhoid  fever  is  never  or  scarcely  ever  to  be  found.  ]STor  is  it  less 

of  Memphis  (Term.),  Am.  J.  July,  1853,  p.  115;  Ilelift,  Zeitschrift,  fiir  Gcsfimmte 
Meuiein,  B.  3,  s.  3<;0,  see  Kdin.  J.  Ixxi.  378;  Michel  Levy,  Bulletin  do  TAc.-id.  viii. 
93'.),  vS:o.  ;  Chargellny-Lagarde,  Bulletin,  xii.  !257. 

1  Ediub.  Journ.  Ixii.  57.  2  See  the  work  cited  above. 


AUTUMNAL    FEVERS.  313 

true,  that  it  is  little  known  in  the  West  Indies.  On  the  other  hand, 
in  parts  of  Europe  where  typhoid  fever  is  common,  intermittent 
and  remittents  are  rare.  At  Constantino,  in  Africa,  periodic  fevers 
are  scarcely  ever  seen,  while  typhoid  cases  are  numerous.  In  the 
city  of  Strasburg,  typhoid  fevers  are  common,  intermittents  rare. 
In  the  citadel,  the  reverse  is  the  case.  In  Paris,  Berlin,  Dresden, 
and  St.  Petersburg,  we  find  typhoid  fever  in  abundance;  but  little  if 
any  of  the  other  disease.  In  Denmark,  periodic  fever  drove  away 
typhoid  fever,  which  reappeared  when  the  former  had  ceased  to 
prevail.  In  England,  much  the  same  thing  has  occurred  ;  for  there, 
as  elsewhere,  "  it  has  been  noticed  that  when  intermittent  fever 
has  yielded  to  improvements  in  cultivation,  drainage,  &c.  typhus 
very  commonly  succeeds."1  Individuals  arriving  from  marshy 
localities,  with  their  systems  saturated  with  the  cause  of  periodic 
fever,  in  places  where  typhoid  fever  prevails,  resist  for  a  long  while 
the  cause  of  the  latter,  and  vice  versa.  (Boudin,  102.) 

In  this  country,  much  the  same  results  are  obtained.  Intermit 
tents  once  were  common  in  the  New  England  States ;  they  have 
made  way,  except  in  a  few  spots,  for  typhoid  fever,  which  is  the 
prevailing  febrile  complaint  of  the  country.  In  the  south  and  west 
the  typhoid  is  gaining  ground,  and  replacing  the  periodic  forms  in 
districts  where  these  once  exercised  an  exclusive  sway.  Speaking 
of  typhoid  fever,  Dr.  Bartlett  says :  "  I  have  often  met  it  in  Ken 
tucky,  where  it  is  sometimes  called  the  red-tongue  fever.  It  is, 
probably,  less  common  in  those  portions  of  the  United  States  which 
are  vitiated  by  the  various  forms  of  intermittent  fever,  than  in  those 
which  are  exempt  from  these  diseases,  although  more  extensive 
and  accurate  observations,  than  have  yet  been  made,  are  necessary 
to  settle  this  point."2  Another  distinguished  writer  of  this  country, 
Dr.  Cain,  of  Charleston,  S.  C.,  in  a  report  on  the  diseases  of  his 
State,  remarks :  "  The  intermittents  and  remittents  were  first  ob 
served  to  lapse  into  the  continued  type  (typhoid),  and  finally  gave 
place  to  the  latter  altogether.  The  typhoid  now  holds,  it  may  be 
said,  undisputed  sway  over  Fairfield,  Newbury,  Chester,  Union, 
Laurens,  Abbeville,  and  Edgefield  Districts,  composing  a  portion 
of  the  clay -hill  region  of  the  State,  but  extending  somewhat  into 

1  Cowan  (C.),  Report  of  the  Reading  Dispensary;  Trans.  Provincial  Association 
(X.  S.),  ii.  202. 

2  Bartlett  on  Fevers,  2d  ed.  84, 


314  PNEUMONIA    AND 

the  middle  or  sand-Mil  region,  affecting  Barn  well,  Sumter,  Ker- 
shaw,  and  Lancaster  Districts."1 

Alluding  to  Bedford  County  (Term.),  Dr.  Lipscombe  remarks : 
"  In  this  part  of  the  county  (the  northern  and  western),  in  former 
years,  intermittents,  remittents,  and  bilious  fevers  were  more  pre 
valent  than  in  the  more  broken  parts  of  the  county.  But  for  the 
last  nine  or  ten  years,  these  types  of  fever  seem  to  have  been  gra 
dually  disappearing,  and  the  enteric  or  typhoid  fever  to  have  taken 
its  place."2  Another  writer,  Dr.  McNally,  reporting  on  the  dis 
eases  of  Lincoln  County,  in  the  same  State,  says  :  "  LTntil  within  the 
last  two  or  three  years,  bilious  remittent,  and  intermittent  and  con 
gestive  fevers  were  the  principal  diseases  which  visited  this  county, 
especially  in  the  summer  and  fall.  They  were  epidemic  every 
year,  in  every  part  of  the  county.  Pea  Kidge  was  more  exempt  than 
any  other  part ;  but  occasionally  they  prevailed  there  as  extensively 
as  elsewhere.  But  for  two  years  past  they  have  been  only  partially 
so.  During  last  summer  and  fall,  they  prevailed  extensively  in  those 
portions  of  the  county  not  visited  by  dysentery  and  typhoid  fever?  At 
Shelby ville.  we  are  told  that  "the  general  type  of  disease,  as 
late  as  about  1846,  was  sthenic."  "  Since  1845  or  6,  this  charac 
teristic  of  disease  has  yielded  to  the  opposite  or  asthenic  form. 
Since  that  period,  we  have  had  more  or  less  enteric  or  typhoid 
fever  to  contend  with;  and  less  and  less  of  the  old-fashioned  bilious, 
remittent,  and  intermittent."4 

In  Alabama,  as  we  are  told  by  Drs.  English5  and  Anderson,6  the 
same  observation  has  been  made.  By  the  former,  it  is  remarked 
that  typhoid  fever  has  pretty  nearly  superseded  the  remittent  and 
congestive  fevers  that  once  prevailed  in  that  State ;  and  the  latter 
writer,  speaking  of  the  diseases  of  South  Alabama,  states  that 
autumnal  fevers  have  totally  declined  there  of  late  years,  and  that 
typhoid — a  case  of  which  was  never  heard  of  till  within  the  last 
five  years — has  become  a  stranger  among  the  inhabitants  of  this 
country.  Indeed,  as  observed  by  Professor  Dickson,7  in  "all  the 

1  Trans.  Am.  Med.  Assoc.  v.  3-58.  2  Hid.  vi.  3:21. 

3  Ibid.  4  I  Lid.  3:27,  328. 

5  N.  0.  Med.  and  Surg.  Journ.  vi.  1G8. 

G  Prize  Essay  on  the  Summer  and  Autumnal  Fevers  of  South  Alabama.  Transl.  of 
Med.  Soc.  of  the  State  of  Alabama,  for  1852. 

7  Report  on  the  lilendii!.^  of  the  Types  of  Fever;  Trans,  of  the  Am.  Med.  Associa 
tion,  v.  lo.j;  Charleston  -Mod.  Journ.  vii.  843. 


AUTUMNAL    FEVERS.  315 

southern  medical  journals,  of  recent  date,  we  find  it  stated  that 
throughout  our  malarial  middle  country — and,  indeed,  though  less 
strikingly,  in  our  lower  alluvial  districts  also — typhoid  fevers  are 
becoming  more  and  more  frequent  in  places  and  settlements,  and 
under  circumstances,  where,  hitherto,  the  ordinary  autumnal  remit 
tents  and  intermittents  prevailed  exclusively.  In  certain  localities, 
the  congestive  forms  of  intermittents  and  remittents  seemed  for 
years  past  to  be  gaining  ground,  but  now  appear  to  be  giving  way, 
in  their  turn,  to  this  newly  observed  type."  It  may  be  proper  to 
remark,  that  the  probability  of  this  conversion  or  substitution  had 
not  escaped  the  prophetic  eye  of  our  great  medical  philosopher,  the 
late  Dr.  Drake,  who  thought  it  likely  that  autumnal  fevers  would 
decrease,  and  typhus  and  typhoid  fevers  become  more  prevalent, 
throughout  the  whole  Valley  of  the  Mississippi. 

Doubtless,  it  is  not  to  be  denied  that  typhoid  fever  is  found 
occasionally  to  prevail  in  malarial  districts  conjointly  with  periodic 
fevers.  Ramcl1  described  the  combination  long  ago,  as  having  fallen 
under  his  observation  in  some  parts  of  the  coast  of  Barbary  and 
Provence,  where  intermittents  were  and  are  still  of  common  occur 
rence.  It  is  also  found  in  La  Vendee,  in  Brittany,  in  sundry  valleys 
near  Paris,  and  other  malarial  parts  of  France,  where  periodic  fevers 
are  matters  of  annual  observation.  In  this  country,  too,  it  is  on  the 
increase,  or  already  prevails  extensively  in  some  aguish  or  fever 
localities,  as  at  Memphis,  for  example,  where  fevers  attributable  to 
malaria  have  not  yet,  notwithstanding  the  appearance  of  the  intruder, 
lessened  in  frequency.2  It  may  be  true,  also,  that  one  of  the  main 
reasons  of  typhoid  fever  being  in  general  less  common  in  rural  dis 
tricts  than  in  cities,  as  also  in  the  marshes  of  Corsica,  Languedoc, 
Italy,  Algeria,  and  this  country,  is  to  be  sought  in  the  sparscness  of 
the  population,  and  in  the  absence  of  other  morbific  agencies  which 
are  found  in  denser  communities,  and  are  known  to  lend  a  powerful 
aid  to  the  production  and  propagation  of  the  disease;  while  the 
causes  of  periodic  fevers,  which  are  not  found  in  the  latter  localities, 
have  not  been  removed  in  the  former,  and  continue,  therefore,  to 
exercise  there  their  baneful  influence.3  But  on  the  latter  point 

1  Memoire  sur  1'Influence   cles  Marais,  &c.  sur  le  Sante   de  1'liomme.     Marseilles, 
an.  x. 

2  Grant,  Sanitary  Condition  of  Memphis,  Am.  J.  July,  1853,  p.  103. 

3  La  Pileur,  Quelques  Objections  a  la   Tlieorie  de  FAntagonisme,  An. 
xxxvi.  G,  7. 


316  PNEUMONIA    AND 

we  liave  nothing  but  conjectures,  which  are  met  by  the  fact  that 
typhoid  fever  exists  now  paramount,  and  is  becoming  a  source  of 
terror  in  many  rural  districts,  where  the  population  is  nearly  as 
sparse  now  as  it  was  previous  to  its  appearance  and  the  decline  of 
its  antagonist,  and  where  the  other  morbid  agents  above  referred 
to  do  not  exist  more  abundantly  now  than  they  did  during  the 
reign  of  the  latter  disease.  Be  this  as  it. may,  examples  of  coexist 
ence  are  not  as  frequent  as  those  of  reciprocal  exclusion ;  and  if  they 
were,  would  not  form  a  valid  objection  to  the  doctrine  of  antago 
nism,  as  we  can  have  no  reason  to  deny  the  possibility  of  the  occa 
sional  existence,  at  the  same  time,  of  the  two  poisons. 

On  these  various  topics  much  more,  I  am  aware,  might  be  said. 
I  might  appeal  also  to  the  phenomenon  of  incubation,  and  show  that 
the  seeds  of  autumnal  fever,  like  those  of  other  zymotic  diseases, 
occasionally  remain  concealed  in  the  system  during  more  or  less 
time  until  brought  into  activity  through  the  operation  of  some 
exciting  agent — often,  under  circumstances  which  prevent  all  idea 
of  attributing  them  solely  to  the  action  of  the  causes  to  which  they 
are  ascribed  by  the  opponents  of  malaria.  Let  individuals  so 
situated — who  have  been  exposed  to  the  influence  of  the  febrific 
cause  in  some  sickly  place — remove  to  a  salubrious  district,  where 
remittent,  intermittent,  and  yellow  fevers  are  not  known,  and  they 
will  not  urifrequently  be  attacked  with  one  of  these  diseases  weeks  or 
months  after  their  arrival,  in  consequence  of  exposure  to  the  action 
of  the  sun,  to  sudden  transition  from  heat  to  cold,  to  a  shower  of 
rain,  or  to  any  other  influence  by  which  the  surface  is  chilled  after 
being  heated,  and  perspiration  checked ;  or  after  a  fit  of  intempe 
rance.  Cases  of  this  kind,  as  we  shall  see  in  a  future  chapter,  are 
not  unfrequent.  Can  we  admit  that  here  we  are  furnished  with  an 
illustration  of  the  production  of  the  fever  by  some  sudden  change 
in  the  sensible  qualities  of  the  atmosphere,  and  independently  of 
the  agency  of  a  febrific  poison?  Had  atmospheric  vicissitudes,  and 
the  other  morbific  agencies  referred  to,  acted  otherwise  than  as 
mere  exciting  causes,  we  should  have  had  as  their  product  a  disease 
commonly  occasioned  by  them  in  the  locality  where  the  attack  has 
taken  place,  and  not  a  variety  of  fever  unknown  there,  but  similar 
to  that  prevailing  at  the  place  whence  those  individuals  came. 

Let -us  notice  another  occurrence.  Two  bodies  of  men  arrive  in 
a  salubrious  locality,  the  one  from  a  place  where  typhoid  fever  pre 
vails,  the  other  where  periodic  fevers  reign.  For  months,  the  first 


AUTUMNAL   FEVERS.  317 

body  remain  subject  to  typhoid  fever,  and  arc  not  troubled  with 
interrnittents.  As  regards  the  other  set,  intermittents  continue  to 
prevail  among  them,  while  they  are  entirely  free  from  typhoid.  If 
so  attacked,  weeks  or  months  after  exposure  to  sickly  localities,  by 
fevers  in  every  way  similar  to  those  they  have  left  behind,  but  un 
like  the  diseases  existing  in  their  new  place  of  sojourn,  it  is  evident 
they  must  have  carried  within  their  system  the  seeds  of  such  fevers; 
—those  from  typhoid  districts  the  seeds  of  typhoid  fever,  those  from 
malarial  districts  the  seeds  of  periodic  fever.  They  are  not  indebted 
for  the  disease  by  which  they  are  there  seized  to  any  morbific  agent 
existing  in  the  place  of  attack,  for  nothing  of  the  kind  is  there  to 
be  found.  It  is  the  result  of  exposure  elsewhere.  Such  being  the 
case,  the  seeds  they  have  thus  carried  with  them,  and  which  are  at 
last  called  into  action,  must  be  of  a  specific  toxical  character,  for 
none  but  morbid  poisons  can  remain  long  latent  in  the  system ; 
and  the  atmospheric  vicissitudes,  through  the  instrumentality  of 
which  the  attack  may  probably  have  been  brought  about,  cannot 
have  acted  otherwise  than  as  a  merely  exciting  agent,  seeing,  par 
ticularly,  that  other  morbific  influences,  a  fit  of  intemperance,  a 
burst  of  passion,  &c,,  produce  at  times  the  same  effect. 

I  might  dwell  on  the  circumstance  that  as,  in  the  above  instances, 
the  cause  of  the  febrile  attacks  under  which  the  individuals  alluded 
to  suffered  were  evidently  of  the  kind  mentioned,  and  not  atmo 
spheric  vicissitudes  or  simple  insolation,  it  would  be  unphilosophi- 
cal  to  attribute  the  same  disease  to  these  latter  agencies  alone,  and 
ignore  the  aid  of  the  malarial  poison  under  consideration.  I 
might  farther  dwell  on  the  process  of  acclimatization,  and  draw 
from  what  we  know  on  the  subject  an  argument  in  favour  of  the 
doctrine  of  the  toxical  nature  of  the  febrile  cause.  Again,  I  might 
point  out,  in  support  of  the  same  doctrine,  that  in  some  forms 
of  autumnal  or  malarial  fever,  individuals  who  have  once  passed 
through  the  disease,  are  like  those  who  have  suffered  from  some 
other  zymotic  diseases,  and,  perfectly  unlike  anything  that  takes 
place  in  complaints  arising  from  heat,  moisture,  or  atmospheric 
vicissitudes,  free  from  a  second  attack.  But  on  some  of  those 
circumstances,  no  additional  illustration  can  be  required ;  and,  as  I 
shall  have  occasion  to  revert  somewhat  in  detail  to  the  others  in  a 
future  chapter,  I  must  here  drop  the  subject. 

As  already  remarked,  enough  has  been  said  to  show  that  au 
tumnal  fevers  depend  for  their  generation  on  something  exhaled 


318  PNEUMONIA    AND 

under  the  influence  of  certain  thermometrical  and  hygrometrical 
conditions  of  the  atmosphere,  from  the  soil  or  the  substances  accu 
mulated  on  its  surface.  Whatever  may  be  our  predilections,  or 
even  our  convictions,  relative  to  the  nature  of  the  substance  thus 
produced — and  the  reader  cannot  have  failed  to  perceive  that,  on 
that  score,  my  opinions  are  already  formed — it  matters  not,  strictly 
speaking,  to  the  question  more  particularly  under  consideration, 
whether  it  consists  of  animalcules,  of  fungi,  of  a  gaseous  or  vapor 
ous  poison,  or  whether  it  must  be  viewed  as  a  vegetable,  or  animal, 
or  vegeto-animal  product.  Nor  is  it  necessary,  in  order  to  sustain 
the  position  assumed,  that  I  should  prove,  any  more  than  has  been 
done  already,  that  the  poison  is  the  result  of  the  decomposition, 
fermentation,  or  putrefaction  of  organic  matter,  or  of  any  other 
known  substance;  or,  that  I  should  establish  beyond  controversy 
that  it  is  independent  or  not  of  those  processes,  and  the  result  of 
some  unknown  and  mysterious  agency  operating  in  some  equally 
mysterious  manner,  or  some  unascertained  materials  floating  in  the 
atmosphere,  but  having  a  predilection  for  particular  localities. 

On  the  animalcular  doctrine,  as  applied  to  malarial  fevers,  and 
other  zymotic  diseases,  we  may  allow  its  modern  advocates,  both 
those  who  regard  it  established  beyond  the  reach  of  doubt,  and 
those  who  consider  it  as  most  plausible — Bradley,1  Pleniz,2  Gattoni,3 
Crawford,4  Mojon,5  S.  Brown,6  Holland,7  Drake,8  Wood,9  Grognier,10 
]STott,ujGrassi,12  Rasori,13  and  Milroy,14  to  repeat  much  that  was  said 
in  former  days  by  Yarro,  Lucretius,  Columella,  Yitruvius,  Kircher, 
Yalisnieri,  Lancisi,  Linnaeus,  Nyander,  Eicia,  Ilartsrcker,  Moufflet. 
The  same  liberty  may  be  extended  to  the  defenders  of  the  doctrine 

1  The  Plague  of  Marseilles  considered,  1730. 

2  Op.  Mod.  Phys.  1702.  3  Mem.  do  la  Soc.  de  Med.  x.  104. 

4  Remarks  on  Quarantines  in  Baltimore,  Observer.  April  and  August,  1807. 

5  Intcrno   alia   natura  del  Miasmo  Cholcroso   Asiatico,    Lucca,   1832.     A   French 
translation   of  this  clever  essay,  by  Julia  de  Fontanelle,  was  published  at  Paris  in 
1832.     See  Kev.  of  it  in  the  N.  A.  Med.  and  Surg.  J. 

6  Dissertation  on  Bil.  Malign.  Fever,  Boston,  1707,  p.  9. 

7  On  the  Hypothesis  of  Insect  Life,  in  Med.  Notes,  chap,  xxxiv.  Am.  Ed. 

8  A  Practical  Treatise,  &c.  on  Epid.  Cholera,  34,  44 ;  Topogr.  and  Dis.  of  the  Val 
ley  of  Mississippi,  i.  723. 

9  Practice  of  Medicine,  i.  147,  30G. 

10  Archive  de  Statistique  du  Dept.  du  Illume. 

11  New  Orleans  Med.  and  Surg.  J.  iv.  503. 

12  Rapport  a  FAcad.  Roy  de  Med.  sur  la  Peste  (Pieces  et  Doc.)  418. 

13  Hid.  14  Quarantine  and  the  Plague,  &c.  11. 


AUTUMNAL   FEVERS.  819 

which  ascribes  febrile  epidemics,  as  well,  indeed,  as  cholera  and  other 
zymotic  diseases,  to  the  toxical  effects  of  various  fungi — Pliny,1 
Varro,2  Ovid,3  Eeinesius,4  Kamazzini,5  Lange,6  Paulet,7  Ilecker,8 
Henle,9  Cawdell,10  Mitchell.11  Either  of  these  doctrines  may,  if  they 
suit  the  fancy  of  their  advocates,  be  adopted.  Either,  separately  con 
sidered,  or  both  conjoined,  may,  for  what  I  know  to  the  contrary,  be 
founded  on  fact  and  solid  reasoning;  though,  judging  from  experi 
ments  recently  adduced  by  a  distinguished  authority,  Prof.  Leidy,12 
I  have  strong  misgivings  on  the  subject.13  We  may  leave  the  che- 

1  Bk.  xviii.  chap.  xxix.  2  De  Re  Rustica,  lib.  i.  cap.  12. 

3  Fast,  lib.  iv.  v   907.  4  P.  218. 

5  Const.  Epid.  Martinensis,  anni  1690,  i.  3,  4. 
e  Quoted  by  Dr.  J.  K.  Mitchell,  38. 

7  Rech.  Hist,  et  Phy.  sur  les  Maladies  Epid.  443. 

8  On  Epid.  of  the  Middle  Ages,  200. 

9  Pathologische  Untersuchungen,  15;  Brit,  and  For.  Med.  Rev.  ix.  398. 

10  A  Disquisition  on  Pestil.  Choi.  Lond.  1848. 

11  Oh  the  Cryptogamous  Orig.  of  Malarious  Dis.,  Philad.  1849. 

12  Flora  and  Fauna  within  Living  Animals,  Introd.  14,  15. 

13  "Many  important  diseases  have  been  supposed  to  originate  from  parasitic  ani 
mals  and  vegetables.     The  former  are  not  the  true  entozoa  ;  for  these  are  too  large, 
and  may  be  detected  by  the  naked  eye ;  but  they  are  to  be  considered  to  be  animal- 
cuke,  so  small  that  they  cannot  be  discerned  even  with  the  highest  powers  of  the  micro 
scope.     But,  independent  of  the  fact  that  the  existence  of  such  entities  is  a  mere 
suspicion,  none  of  the  known  ariimalculre  are  poisonous.     At  various  times,  I  have 
purposely  swallowed  large  draughts  of  water  containing  myriads  of  Monas,  Vibrio, 
Euglenia,  Volvox,  Leucophrys,  Paramecium,  Vorticella,  and  without  ever  having  per 
ceived  any  subsequent  effect. 

"The  production  of  certain  diseases,  however,  through  the  agency  of  entophyta,  is 
no  longer  a  subject  of  doubt,  as  in  the  case  of  the  Muscardine  in  the  silkworm,  the 
Mycoderm  of  Porrigo  favosa  in  man,  &c.  But  that  malarial  and  epidemic  fevers  have 
their  origin  in  cryptogamic  vegetables  or  spores,  requires  yet  a  single  proof.  If  such 
were  the  case,  these  minute  vegetables  and  spores,  conveyed  through  the  air,  and 
introduced  into  the  body  in  respiration,  could  be  detected.  The  minutest  of  all 
known  living  beings  is  the  vibrio  lineola  of  Muller,  measuring  only  the  36,000th  of  an 
inch;  and  the  smallest  known  vegetable  spore  is  very  much  larger  than  this,  whilst 
particles  of  inorganic  matter  can  be  distinguished  the  200,000th  of  an  inch  in  size. 

"  I  have  frequently  examined  the  rains  and  dews  of  localities  in  which  intermittents 
were  epidemic  upon  the  Schuylkill  and  Susquehanna  Pavers,  but  without  being  able 
to  detect  animalcule,  spores,  or  even  any  solid  particles  whatever.  I  have  examined 
the  air  itself  for  such  bodies  by  passing  a  current  through  clear  water.  This  was 
done  by  means  of  a  bottle  with  two  tubes  passing  through  a  cork  stopper  ;  one  tube 
dipping  into  the  water,  the  other  reaching  not  quite  to  its  surface.  By  sucking  upon 
the  latter  tube,  a  current  of  air  passed  through  the  former,  and  was  deprived  in  its 
course  of  any  solid  particles.  Ordinarily,  when  the  atmosphere  was  still,  early  in  the 
morning,  or  in  the  evening,  neither  spores  nor  animalcules  could  be  detected.  When 


320  PNEUMONIA    AND 

mists  to  discuss  the  claims  of  the  various  gases  to  the  distinction  of 
producing  the  morbid  effects  in  question.  We  may  grant,  if  per 
chance  any  one  insist  upon  it,  that  Sylvius  de  la  Boe  had  good 
reason  for  believing  that  the  cause  of  fevers  is  of  a  saline  and  sul 
phurous  nature  ;  or  that  it  is  acid,  as  maintained  by  Kamazzini;  or 
that  it  consists  in  an  oxide  of  azote,  as  believed  by  Textoris.  We 
may  allow  Dr.  Balme  to  plead  the  cause  of  his  septon  of  oxygenated 
azote,  a  substance  not  very  different  from  that  which,  under  the 
same  name  of  septon,  enjoyed  some  celebrity  on  this  side  of  the 
Atlantic  under  the  fostering  care  of  our  distinguished  countryman, 
the  late  Dr.  S.  L.  Mitchell,  of  ~N&w  York.  We  may  also  allow  Pro 
fessor  Dunglison  to  write  and  teach  that  vegetable  matter  has 
nothing  to  do  in  the  production  of  the  morbific  agent.  We  may, 
besides,  offer  no  objections  to  the  opinion  of  Dr.  Warren,  and  others, 
who  are  no  less  zealous  in  absolving  animal  matter  from  all  blame 
in  reference  to  the  effects  in  question ;  and  we  may  go  so  far,  for  the 
sake  of  argument,  as  to  admit,  if  hard  pressed  by  some  fastidious 
disputant,  that  the  cause  is  not  the  production  of  the  decomposition 
of  any  kind  of  organic  matter.  All  I  insist  upon  at  present  is,  that 
be  its  nature,  the  materials  from  which  it  is  derived,  and  the  pro 
cess  by  which  it  is  generated,  what  they  may,  the  febrile  poison  is 
a  stranger  to,  and  must  not  be  confounded  with,  the  natural  and 
unchangeable  constituent  elements  of  the  atmosphere;  that  it  is 
distingt  from,  and  independent  of,  mere  modifications  in  the  sensi 
ble  qualities  of  the  latter ;  that  it  is  suspended  and  floats  in  it,  and 
is  wafted  by  the  wind ;  that  it  possesses  an  individuality  of  its  own, 
and  serves,  by  its  poisonous  properties,  to  render  the  air  of  locali 
ties  where  it  is  generated  or  conveyed  insalubrious,  and  a  fruitful 
source  of  fever. 

Other  objections   urged  against   the   malarial  origin   of  periodic  or 
autumnal  fevers. — It  can  scarcely  be  necessary  to  occupy  our  time 

piles  of  decaying  sticks,  or  dry  leaves  were  stirred  up,  or  the  dust  was  blown  about 
by  the  wind,  a  host  of  most  incongruous  objects  could  be  obtained  from  the  air;  none, 
however,  which  could  be  supposed  capable  of  producing  disease.  To  assert,  under  the 
circumstances,  that  there  are  spores  and  animalcule  capable  of  giving  rise  to  epidemics, 
but  not  discernible  by  any  means  at  our  command,  is  absurd  :  as  it  is  only  saying,  in 
other  words,  that  such  spores  and  animalculae  are  liquid  and  dissolved  in  the  air,  or 
in  a  condition  of  chemical  solution."'  (Leidy,  Flora  and  F<ui>ni  trithin  /.iri/iy  Animals, 
Introduction,  14,  15.) 


AUTUMNAL   FEVERS.  321 

in  examining  in  detail  the  value  of  various  other  objections  urged 
against  the  existence  and  febrific  power  of  malarial  exhalations. 

It  is  not  likely  that  those  who  believe  in  the  morbific  agency 
of  these,  and  recognize  in  them  the  essential  or  efficient  cause 
of  autumnal  fevers,  will  be  disquieted  by  the  reasons  assigned  in 
opposition  by  Giannini1  and  others,  who  remark  that  the  exist 
ence  of  malaria  may  be  disproved  on  the  following  grounds :  1. 
When  a  morbific  matter  is  introduced  into  the  human  body,  it 
manifests  its  presence  by  the  occurrence  of  cutaneous  eruptions 
and  spots — phenomena  which  are  never  observed  in  malarial  or 
periodic  fevers.  2.  The  morbific  matter,  when  introduced,  is  usu 
ally  expelled  by  means  of  critical  discharges,  more  particularly  by 
sweats.  This  evacuation,  in  intermittent  fever,  is  an  effect  of  the 
hot  stage,  and  not  an  expulsive  effort  to  get  rid  of  the  miasm. 
Thus,  when  this  last-mentioned  stage  is  arrested  by  means  of  cold 
immersions,  the  sweating  process  does  not  take  place.  3.  Morbific 
matters,  inimical  to  the  organism,  when  introduced  into  the  body,  or 
simply  applied  to  the  surface,  usually  manifest  the  power  of  repro 
duction  and  multiplication.  Through  means  of  this  power,  a  similar 
disease  is  reproduced  in  those  who  come  in  contact  with  the  sick. 
Nothing  of  the  kind  takes  place  in  intermittent  fever,  which  pro 
duces  no  morbific  matter  or  excretion,  and  is  not,  therefore,  con 
tagious.  4.  Periodic  fevers,  which  are  generally  thought  to  be 
produced  by  the  paludal  miasm,  often  terminate  after  the  first 
paroxysm.  If  the  disease  arose  from  the  miasm,  it  is  difficult  to 
comprehend  how,  in  so  short  a  time,  that  cause  could  be  expelled, 
considering  that  all  morbific  matters  that  produce  fever  in  the 
living  system,  remain  in  it  some  days  before  being  expelled. 
Peruvian  bark  and  cold  affusions  cannot  be  supposed  to  act  in 
these  cases  by  neutralizing  the  alleged  poison,  inasmuch  as  the 
same  means  produce  the  same  curative  effects  in  periodic  fevers 
arising  from  other  and  totally  different  causes.  5.  Diseases  pro 
duced  by  foreign  matters  introduced  into  the  system  are  all  com 
municable  by  contact.  So  far  from  being  the  vehicle  of  contagious 
diseases,  the  atmosphere  decomposes  all  contagions.  Reasoning 
from  analogy,  therefore,  we  may  conclude  that  the  atmosphere 
would  do  the  same  as  regards  the  alleged  miasm,  did  it  exist.  6.  If 
there  existed  a  paludal  miasm,  its  effect  would  be  specific  and  uni- 

•  Vol.  i.  230,  231. 

21 


322  PNEUMONIA    AND 

form.  So  far  from  this,  the  effect  of  the  pretended  miasm  is  multi 
form.  It  gives  rise,  not  only  to  periodic  fevers,  but  also  to  cachexia, 
marasmus,  abdominal  obstructions,  dyspepsia,  chlorosis,  dropsy,  &c. 
7.  The  cause  often  operates  too  suddenly  to  allow  us  to  believe  that 
it  consists  in  a  miasm.  If  such  were  the  case,  we  should  be  led  to 
admit  that  in  a  few  hours  the  miasm  has  been  introduced,  that  it 
has  circulated  in  the  lymphatic  vessels,  and  next  in  the  arteries 
and  veins ;  or  that,  after  having  penetrated  the  lungs,  in  opposition 
to  the  known  fact  that  these  organs  receive  no  other  gases  than 
oxygen,  it  has  been  able  to  exercise  an  action  on  the  nerves — a 
result  which  does  not  obtain  in  diseases  produced  by  morbific 
agents  of  a  poisonous  character.  Besides,  the  same  effect  may  be 
produced  by  any  other  cause,  since  it  is  proved  that  an  attack  of 
intermittent  fever  is  often  brought  on  by  simply  sleeping  one  night 
in  the  open  air  in  places  free  from  marshes.  Now,  as  in  instances 
of  this  kind,  we  cannot  refer  the  disease  to  any  other  influence 
than  that  of  cold  on  the  nervous  system,  we  need  not  attribute  the 
other  phenomena  to  a  different  cause. 

To  these  objections  it  may  be  remarked :  1.  That  all  morbific 
poisons,  introduced  into  the  system,  do  not  manifest  their  presence 
therein  by  cutaneous  eruptions  and  spots ;  as  proved  by  that  pro 
ducing  hooping-cough.  2.  Diseases  caused  by  such  poisons  ter 
minate  often  without  the  occurrence  of  critical  discharges — that  by 
sweat  particularly — while,  on  the  other  hand,  autumnal  fevers,  of 
the  remittent  or  continued  kind,  which  belong  to  the  same  class  with 
intermittents,  are  frequently  judged  by  such  discharges.  3.  Nothing 
has  as. yet  been  said  calculated  to  prove  the  contagious  character  of 
cholera;  the  origin  of  which,  from  a  morbific  agent  introduced  into 
the  system,  admits  of  no  doubt.  Many  poisonous  animal  matters, 
when  introduced  under  the  skin,  cause  dangerous  and  even  deadly 
diseases  of  a  specific  kind,  without  imparting  to  the  system  the  power 
of  reproducing  a  similar  matter  endowed  with  poisonous  qualities. 
4.  The  cure  of  an  intermittent  fever  by  cinchona,  after  the  first 
paroxysm,  is  no  proof  of  the  non-existence  of  a  malarial  poison ; 
as  there  is  no  reason  for  disbelieving  the  possibility  of  a  disease 
being  produced  by  a  small  portion  of  miasmal  poison,  terminating 
with  or  without  a  critical  discharge,  in  a  short  space  of  time. 
Some  poisons  require  for  their  elimination  a  certain  and  fixed 
number  of  days ;  but  it  does  not  follow  that  in  all  the  duration 
must  always  be  prolonged.  Besides,  in  some  fevers,  due  to  the 


AUTUMNAL   FEVERS.  323 

same  causes,  or  to  influences  closely  allied  to  them,  the  disease  runs 
a  long  and  definite  course;  and,  when  established,  is  not  arrested 
by  the  means  mentioned.  If  arrested  by  cinchona,  the  effect  is 
due,  as  is  also  the  cure  of  intermittent  fever,  to  the  control  exer 
cised  by  this  remedy,  and  some  other  therapeutic  agents,  over  all 
affections  that  assume  the  periodic  type,  whether  those  affections 
be  produced  by  one  set  of  causes  or  another.  Giannini  himself, 
admits  that  typhus,  petechial,  pestilential,  and  other  forms  of  fever, 
which  he  regards  as  the  effect  of  morbific  poisons,  may  be,  and 
often  are  cut  short,  or  greatly  abridged  in  their  duration,  by  cold 
immersions.  5.  It  is  not  correct  to  say  that  the  atmosphere  is  never 
the  vehicle  of  contagions ;  since  exposure  to  smallpox  or  like  com 
plaints,  without  contact,  is  generally  followed,  in  unprotected  indi 
viduals,  by  an  attack  of  the  disease.  The  poison,  in  these  cases,  is 
certainly  conveyed  from  the  sick  to  the  well  through  the  medium  of 
the  atmosphere ;  and  if  the  latter  does  not  always  decompose  it, 
immediately  on  its  escape  from  the  diseased  body,  there  is  no  reason 
to  deny  that  it  may  fail  to  do  so  in  regard  to  the  malaria  producing 
periodic  fevers.  6.  The  diseases  produced  by  malaria  are  specific 
and  uniform — each  variety  of  the  poison  producing  a  different  form 
of  fever.  The  affections  enumerated  in  proof  of  the  multiform  effect 
of  marsh  poison  are  only  sequelae  of  the  specific  disease,  or  the 
result  of  the  gradual  and  long-continued  action  of  the  cause.  7. 
And  lastly,  even  if  it  were  true  that  no  other  gas  than  oxygen 
found  entrance  into  the  lungs — which  is  far  from  being  the  case — 
the  occurrence  of  fever  after  slight  and  momentary  exposure  to 
marsh  air,  is  no  proof  of  the  non-existence  of  miasm ;  for  the  small 
pox  and  other  diseases  depending  on  morbific  matters  introduced 
into  the  system,  have  often  been  occasioned  by  a  few  moments'  ex 
posure  to  individuals  labouring  under  them. 

To  only  one  more  objection  shall  I  devote  a  few  remarks.  It  has 
been  said,  as  a  proof  of  defective  and  erroneous  reasoning  on  the  part 
of  the  advocates  of  the  mode  of  origin  of  autumnal  fevers  under  con 
sideration,  and  as  an  evidence  of  a  culpable  violation  of  the  rules  of 
induction,  that  such  individuals  insist  that  the  same  cause — not  "known 
even  to  exist  at  all — may  and  does  produce  different  and  distinct  dis 
eases  in  different  individuals  exposed  under  the  same  circumstances. 
Now,  to  this  I  have  only  to  say,  that  I  cannot  at  this  moment  recall 
to  mind  a  single  writer  of  sane  intellect,  or  whose  opinion  is  worth 
notice,  who  has  ventured  and  pertinaciously  insisted  on  such  an 


S24:  PNEUMONIA    AND 

assertion.  That  some  have  believed,  and  continue  to  believe,  that 
the  same  cause — miasmata — produces  what  other  pathologists  regard 
as  different  and  distinct  forms  of  fever,  is  perfectly  well  known. 
But  such  writers,  themselves,  while  believing  in  the  identity  of  the 
cause,  believe  also  in  the  identity  of  all  the  fevers  in  question ; 
holding  these  to  differ  from  each  other  in  nothing  but  the  degree 
of  their  violence,  the  organs  that  may  be  implicated,  and  other 
circumstances  of  like  import.  Hence  the  remark  cannot  apply  to 
them.  By  others,  nothing  of  the  sort,  so  far  as  I  can  find,  has  been 
advanced.  By  them,  it  has  doubtless  been  said,  very  correctly,  as 
I  think,  that  miasmata  or  exhalations,  produce  different  forms  of 
fever ;  but  while  doing  soj  they  have  not  wished  to  be  understood 
as  maintaining  that  those  exhalations  are  always  identically  the 
same  in  their  nature.  So  far  from  this,  they  think  themselves 
justified  in  the  belief  that,  considering  the  great  diversity  of  effects 
produced,  as  evinced  by  the  phenomena  and  anatomical  characters 
noticed  in  those  several  forms  of  fever,  poisons  exhaled  from 
various  sources  of  infection  differ  materially  in  composition  and 
nature.  The  exhalations  from  our  wharves,  from  the  timber  of 
ships,  and  some  other  sources,  produce  yellow  fever,  and  never 
intermittent  fever.  Those  from  swamps,  marshes,  &c.,  give  rise  to 
periodic  fevers  of  different  grades — never  to  yellow  fever  properly 
so  called.  In  Paris,  and  other  parts  of  France  and  Europe,  and  in 
various  sections  of  our  country,  some  effluvia  appear  to  give  rise 
to  typhoid  fever.  In  several  localities  of  Ireland,  Scotland,  and 
England,  certain  exhalations  have  occasioned  a  peculiar  form  of 
fever,  which,  from  one  of  its  noted  characteristics,  has  been  deno 
minated  the  relapsing  fever.  The  morbus  Hungaricus,  of  some 
centuries  past,  bore  but  a  feeble  resemblance  to  the  Athenian 
plague,  described  by  Thucydides ;  to  the  Oriental  plague  of  the 
present  day ;  to  the  sweating  sickness,  and  to  the  black  death  of  the 
14th  century .;  or,  again,  to  the  typhoid  fever  of  Paris,  the  typhus  of 
London,  or  the  typhoid  remittent  of  our  negro  alleys ;  while  none 
of  them  resemble  exactly  the  true  yellow  fever.  Whatever  view 
we  may  take  of  the  contagious  character  of  typhus,  it  is  not  to  be 
denied  that  it  arises  often  from  miasmatic  exhalations  of  some  sort. 
Even  among  fevers  that  are  strictly  speaking  of  malarial  origin, 
some  difference  occurs  in  their  symptornatological.  and  other  cha 
racters.  The  jungle  fever  of  India  is  not  exactly  the  same  in  form 
as  the  remittent  of  Africa:  the  fever  of  Batavia  differs  in  some 


AUTUMNAL   FEVERS.  825 

respects  from  the  bilious  remittent  of  this  country,  or  of  the  Gambia. 
The  febrile  diseases  of  Koine  are  not  precisely  similar  to  those  of 
the  West  Indies  or  Batavia ;  and  the  Walcheren  fever  differs  in  like 
manner  from  both  of  these,  or  from  that  of  Breskau.  In  France, 
the  fevers  of  Eochefort  do  not  present  the  very  same  characters  as 
those  of  Bresse  or  of  the  plain  of  Forez. 

The  Mediterranean  remittent,  described  by  Sir  William  Burnett, 
is  somewhat  unlike  the  periodic  fevers  of  England  and  of  northern 
Europe.  It  differs  in  some  particulars  from  that  of  Greece,  an 
account  of  which  is  found  in  the  justly  celebrated  books  of  Epi 
demics  of  Hippocrates,  or  .of  Algeria,  or  the  Morea.  Our  negro 
fever  of  1822,  and  the  Bunker  Street  fever  of  New  York,  were  too 
unlike  yellow  fever  on  the  one  hand,  and  common  periodic  fever 
on  the  other,  to  be  supposed  to  have  arisen  from  the  agency  of 
precisely  the  same  poison  as  these. 

This  probable  diversity  in  the  nature  and  composition  of  the 
miasms  in  question,  as  exhibited  by  the  diversity  of  the  febrile 
phenomena  they  produce,  has  called  the  attention,  and  met  with  the 
assent  of  many  writers  of  former  and  present  times.  It  is  referred 
to  by  Lancisi  -,1  approved  of  by  Eochoux,2  Ferrus,3  Desland,4  Littre',5 
and  many  others  of  equal  note  ;  and  particularly  insisted  upon  by 
Twining,6  J.  M.  Smith,7  and  Monfalcon.8 

Those  fevers,  though  bearing  a  close  family  resemblance  to  each 
other,  are  all  more  or  less  different  in  their  phenomena,  mode  of 
progression,  and  anatomical  characters,  but  yet  are  all  avowedly 
the  offspring  of  miasmal  effluvia.  Here,  the  cause  giving  rise  to 
each  form,  though  included  with  others  under  the  generic  name  of 
miasma  or  malaria,  is  also  regarded  as  different  in  its  composition 
or  in  the  proportion  of  its  component  parts.  This  is  what  is 
affirmed;  and  not  the  absurdity  sometimes  charged  on  the  advocates 
of  the  malarial  origin  of  fevers,  that  a  cause  identically  the  same 
may  and  does  produce  different  and  distinct  diseases  in  individuals 
exposed  to  it  under  the  same  circumstances.  Individuals  exposed 

1  Op.  cit.  cap.  xi.  34-3G. 

2  Recherches  sur  les  Differentes  Maladies,  &c.  135. 

3  Diet,  de  Medecine,  1st  ed.  viii.  G8.  4  Diet,  de  Med.  Pratique,  vii.  73. 
5  (Euvres  d' Hippocrates,  ii.  578.  6  Diseases  of  Bengal,  ii.  288. 

7  On  Epidemics,  48,  67,  &c. 

8  Op.  cit.  65,  69.     See  also  Rev.  of  Deveze,  Med.  Repos.  xxi.  187 ;  Forry,  op.  cit. 
285,  291 ;  Desportes,  Bulletin  de  1'Acad.  v.  380. 


326  PNEUMONIA    AND 

to  the  same  cause,  under  the  same  circumstances,  will  have  the 
same  disease.  If  the  diseases  produced  differ,  the  cause  must  be 
different  too;  because  the  same  morbific  agents  cannot  occasion 
different  effects,  any  more  than  different  agents  can  occasion  the 
same  effect.1 

If  the  causes  of  those  diseases  we^e  precisely  the  same,  and  the 
latter  consequently  of  similar  nature,  they  would  be  convertible 
into  each  other,  and  show  themselves  in  the  same  place ;  yellow, 
or  typhoid,  or  relapsing  fever  would,  under  particular  circum 
stances,  be  converted  into  a  remittent  or  intermittent  fever,  and 
•vice  versa;  and,  where  the  one  form  of  febrile  complaints  exists,  the 
other  forms  would  appear  too.  But,  notwithstanding  all  that  may 
be  said  to  the  contrary,  experience  shows  that  such  is  not  the  case ; 
a  true  yellow  fever  has  never  been  converted  into  a  typhoid  or  an 
intermittent  fever.  They  may,  and  do  often  mix  or  combine 
together ;  their  types  may  blend,  but  they  remain  independent  of 
each  other,  as  will  be  dwelt  upon  on  some  other  occasion.  Where 
intermittent  fever  prevails,  yellow  fever  frequently  never  shows 
itself;  and  in  places  most  visited  by  yellow  fever,  the  other  is  never 
or  very  seldom  seen. 

In  the  Islands  of  Dominica,  Demerara,  and  St.  Lucia,  common 
miasmal  fevers  prevail  annually,  while  the  yellow  fever  appears  at 
irregular  intervals.  In  Barbadoes,  on  the  contrary,  the  latter  dis 
ease  is  of  frequent  occurrence,  and  the  former  scarcely  known. 
Bilious  remittent  fever,  in  its  worst  forms,  is  as  prevalent  in  India, 
in  Eastern  Europe,  and  in  all  parts  of  Africa,  as  in  our  Southern 
States,  the  West  Indies,  and  the  western  coast  of  Africa ;  yet,  not- 

1  Cases  are  not  wanting  to  show  that  the  same  locality  will,  under  particular 
hygienic  and  atmospheric  conditions,  produce  different  forms  of  fever.  Witness  the 
following :  At  a  short  distance  from  Drieuze,  in  France,  is  situated  a  large  pond  called 
Lindre  Basse,  which,  for  special  purposes,  is  made  to  undergo  certain  changes.  It  is 
two  years  full  and  one  year  empty.  The  first  year  it  is  only  half-filled — the  second 
year  quite  so;  and  the  third,  after  the  fish  have  been  taken  out,  it  is  dried  and  cul 
tivated.  During  the  first  year,  intermittents  prevail ;  during  the  second,  typhoid 
fevers  take  the  place  of  these,  while  during  the  third,  malignant  carbuncular  diseases 
succeed  to  both.1  This  order  of  succession  has  been  regularly  observed  during  the 
last  twenty  years.2 


1  Ancelon,  Memoires  sur  les  Fievres  Typhoidcs  periotliquement  devcloppees  par  le?  emanations  dc 
1'Etang  de  Lindre  Basse.     Nancy,  1847  ;  Melier,  Mem.  de  1'Academie  de  Med.  xiii.  657. 

2  A  change  in  the  rotation  in  1848-49,  has  altered  the  order  of  succession  of  these  diseases. — Comptes 
Ecndus,  1850. 


AUTUMNAL   FEVERS.  327 

withstanding,  the  yellow  fever  is  seldom  if  ever  seen  there ;  while 
it  is  very  common  in  the  others.  Bilious  remittents  and  intermit- 
tents  prevail  as  extensively,  and  with  as  much  violence,  in  the 
interior  of  unhealthy  countries  as  near  the  sea ;  the  yellow  fever, 
on  the  contrary,  is  confined  within  narrow  limits,  and  is  generally 
observed  on  the  sea-coast,  and  along  navigable  streams,  and  never 
extends  far  into  the  interior.  The  yellow  fever,  as  we  have  seen, 
has  often  been  known  to  arise  from  the  foul  exhalations  of  ships ; 
no  instance,  so  far  as  I  have  been  able  to  ascertain,  has  as  yet 
occurred  of  epidemics  of  remittent  or  intermittent  fevers  having 
broken  out  at  sea,  or  been  traced  to  the  decayed  timber,  or  dirty 
bilge-water,  or  fermenting  cargo  of  a  ship.  If  they  break  out  there, 
they  have  invariably  been  brought  from  elsewhere.  The  yellow 
fever  is,  strictly  speaking,  a  disease  of  cities,  or  of  places  containing 
a  dense  population.  That  it  has  sometimes  attacked  small  towns, 
villages,  plantations,  or  rural  districts,  is  true ;  but  such  instances 
are  rare,  and  have  always  occurred  along  large  watercourses.  The 
bilious  remittents  or  inter mittents,  though  occasionally  seen  in  city 
localities,  prevail  more  generally  in  the  suburbs  or  adjacent  coun 
try,  to  which  the  other  never  extends.  Although  it  often  happens 
that  an  epidemic  of  yellow  fever  is  accompanied  with  a  like  preva 
lence  of  remittents  and  intermittents  in  the  surrounding  country, 
or,  perchance,  in  the  infected  place  itself,  the  occurrence  is  not 
constant ;  for  instances  are  found  when,  daring  severe  visitations, 
the  country  or  suburbs  have  remained  free  from  common  malarial 
fevers.  On  the  other  hand,  in  some  very  unhealthy  seasons,  both 
in  the  West  Indies  and  in  our  Southern  and  Middle  States,  when 
the  fevers  have  prevailed  most  extensively,  the  yellow  fever  has 
not  made  its  appearance. 

To  those  who  reject  these  views  as  unphilosophical  and  absurd, 
it  may  be  asked  whether  they  are  more  so  than  others  to  which 
"they  are  forced  to  give  their  assent,  respecting  phenomena  wit 
nessed  every  day.  Take  the  process  of  putrefaction,  as  an  example. 
All  animal  substances  give  by  this  process  the  same  products,  but 
they  do  not  follow  exactly  the  same  laws,  and  present  the  same 
phenomena.  These  are  often  dependent  on  a  difference  in  the 
proportion  and  nature  of  their  constituent  principles.  Fourcroy, 
a  high  authority  on  this  subject,  remarks:  "Each  substance  has  its 
particular  mode  of  comporting  itself  while  undergoing  the  putrefy- 


328  PNEUMONIA    AND 

ing  process."     Each  gives  out  a  particular  odour,  and  each  pro 
duces  a  somewhat,  different  effect  by  its  action  on  living  beings.1 

But  we  ask  for  proofs,  not  assertions,  and  unsupported  denials; 
and  say,  to  all  who  condemn  a  doctrine  which  we  regard  as  resting 
on  the  most  solid  foundations,  and  which,  as  every  one  must  ac 
knowledge,  has  received  the  sanction  of  the  highest  professional 
authorities,  and  enumerates  among  its  advocates  the  larger  number 
of  medical  inquirers,  that,  to  succeed  in  their  efforts,  something 
more  will  be  required  at  their  hands,  than  the  mere  assertion  that 
those  who  advocate  that  doctrine  labour  under  a  most  egregious  and 
unpardonable  error,  and  are  neither  more  nor  less  than  open  to 
the  charge  of  hazarding  a  sheer  hypothesis  at  complete  variance 
with  the  results  of  daily  observation  and  the  commonest  principles 
of  a  sound  philosophy,  and  worthy  only  of  those  unenlightened 
minds  who  have  lagged  behind  during  the  onward  march  of  scien 
tific  knowledge.  As  for  myself,  whether  it  be  from  obtuseness  of 
intellect,  ignorance  of  important  facts,  or  other  circumstances  of  like 
import,  matters  not;  but  I  cannot  help  thinking  that,  notwithstanding 
all  that  may  be  affirmed  to  the  contrary,  the  doctrine  of  malaria  is, 
to  say  the  least,  entitled  to  our  most  respectful  consideration ;  that 
enough  has  been  adduced  to  satisfy  the  minds  of  ordinary  inquirers, 
that  those  who  admit  the  claims  of  that  doctrine  to  be  so  viewed, 
are  not  far  from  the  truth;  that  nothing,  at  least,  has  so  far  been 
done  or  said  to  prove  the  contrary ;  and  that  the  opponents  of  the 
malarial  origin  of  autumnal  fevers  would  confer  an  inestimable 
service  on  the  profession,  if,  instead  of  contenting  themselves,  as 
they  have  but  too  generally  done,  with  summarily  disposing  of  the 
subject  with  a  few  words  of  contemptuous  denial,  or  dwelling  on 
morbific  influences,  not  one  of  which  can,  unaided  by  a  more  effi 
cient  cause,  produce  any  form  of  that  disease,  they  were  at  once  to 
refute  all  that  has  been  said  in  support  of  that  origin ;  to  show, 
clearly  and  positively,  how  and  in  what  manner  their  opponents' 
have  erred  and  continue  to  err ;  and  to  furnish  us,  in  detail,  with 
facts  and  arguments  as  numerous  and  strong  as  thoss  they  seek 
to  overthrow. 

In  the  meanwhile,  at  the  risk  of  incurring  the  charge  of  repeti 
tion,  I  must,  before  concluding  the  subject  of  malaria,  lay  down 
a  few  propositions,  which,  it  appears  to  me,  we  are  warranted  in 

1  Julia  de  Fontenelle,  op.  ci(.  11G. 


AUTUMNAL    FEVERS.  329 

drawing  from  a  survey  of  all  the  facts  and  statements  which  have 
been  passed  in  review. 

1.  The  doctrine  of  malaria,  though  of  ancient  origin,  and  very 
generally  admitted,  has  encountered,  and  continues  to  encounter 
opposition. 

2.  The  appearance  of  autumnal  or  periodic  fevers,  where  there 
are  no  marshes,  properly  speaking,  does  not  disprove  the  existence 
or  agency  of  malaria  in  the  production  of  that  class  of  disease,  inas 
much  as  there  is  nothing  to  hinder  morbid  exhalations  from  being 
furnished  by  terrestrial  surfaces  of  a  different  character,  and  no 
writer  of  any  reputation  has  denied  the  fact  of  such  occurrences. 

3.  The  constant  association  of  these  fevers  with  peculiar  cha 
racters  and   conditions  of  localities,  and  their  absence  or  cessa 
tion  where  these  characters  and  conditions  clo  not  exist,  or,  having 
existed,  have  ceased  to  do  so,  through  the  operation  of  artificial  or 
other  means,  lead  to  the  opinion  of  the  evolvement  from  those 
localities  of  some  peculiar  morbific  poisonous  substance  from  the 
soil,  or  the  materials  by  which  it  is  covered  ;  and  of  the  connection, 
as  cause  and  effect,  between  this  exhaled  substance  and  the  diseases 
in  question. 

4.  The  inability  of  the  chemist  to  detect  this  malarial  poison  in 
the  atmosphere  of  sickly  localities,  and  to  point  out  its  nature,  does 
not  disprove  its  existence,  inasmuch  as  other  substances,  the  pre 
sence  of  which  cannot  be  doubted,  equally  escape  detection. 

5.  Atmospheric  heat  alone  will  not  serve  to  account  for  the  pro 
duction  of  periodic  fevers,  of  various  grades  and  types ;  for  these 
fail  to  appear  in  seasons  when,  and  in  localities  where,  the  ther 
mometer  ranges  higher  than  at  other  seasons  when,  and  in  places 
where,  they  prevail  extensively.     Besides,  instances  are  not  rare 
when  fevers  have  stopped,  though  the  heat  continued  unchanged, 
and  apparently  from  the  influence  of  a  very  high  range  of  tempe 
rature. 

6.  Nor  can  terrestrial  or  visible  atmospheric  humidity  account 
alone  for  the  effect  under  consideration.     Though  fevers  often  break 
out  or  prevail  during  wet  weather,  they  usually  cease  when  this 
humidity  is  at  its  height,  and  reign  most  generally  during  the  dry 
ing  process — often  during  very  dry  spells  of  weather. 

7.  Fevers  of  the  kind  mentioned  cannot  be  due  simply  to  a  high 
dew-point,  for  they  exist  and  are  rife  when  the  latter  is  not  higher 
than  in  healthy  seasons. 


330  PNEUMONIA    AND 

8.  For  reasons  assigned,  the  efficient  cause  of  fever  cannot  be 
sought  in  any  peculiar  modification  in  the  electrical  state  of  the 
atmosphere.     This  fluid,  by  its  excess  or  deficiency,  may  and  does 
no  doubt  exercise  an  agency  in  the  matter ;   but  that  agency  is 
evidently  limited  to  placing  the  system  in  a  proper  condition  to 
receive  the  impress  of  a  morbific  cause;  to  furthering,  when  defi 
cient,  the  formation  of  the  latter,  or,  when  in  excess,  to  neutralizing 
or  destroying  its  effects.     But,  in  all  cases,  the  presence  of  such  a 
cause  is  required,  before  autumnal  fevers  can  be  produced. 

9.  The  same  may  be  said  of  atmospheric  vicissitudes.     These 
may  and  do  often  occur,  without  periodic  fevers  being  the  conse 
quence;  and,  conversely,  those  fevers  frequently  occur  without  ap 
preciable  vicissitudes. 

10.  The  attack  comes  on  too  suddenly,  and,  not  unfrequently, 
after  too  transient  an   exposure  to  evident  sources  of  infection, 
without  the  possible  concurrence  of  any  other  influencing  agency ; 
at  other  times,  it  occurs  too  long  after  a  residence  in,  or  visit  to 
places  where  the  disease  is  known  to  prevail,  to  be  the  effect  of  any 
other  cause  than  a  morbid  poison  introduced  into  the  system. 

11.  The  opinion  of  the  existence  and  agency  of  such  a  poison 
will  appear  the  more  natural,  when  we  find  that  the  danger  of  an 
attack  is   generally  proportionate  to  the  proximity  to   localities 
where  these  diseases  prevail ; — the  other  agencies  being  the  same 
beyond  as  within  the  sphere  of  their  prevalence ; — that  vessels  on  a 
sickly  coast  remain  healthy  so  long  as  they  do  not  approach  the 
land ;  that  they  become  again  healthy  by  removing  to  a  short  dis 
tance,  or  by  merely  shifting  their  position;   and  that  individuals 
from  on  board,  who  land,  and  those  especially  who  sleep  on  shore, 
are  almost  certain  of  being  attacked. 

12.  The  development  and  prevalence  of  fever  on  board  of  ships, 
when  other  vessels  in  the  vicinity  remain  healthy;  its  occurrence 
only  in  limited  parts  of  the  under  decks;   and  its  being  arrested 
by  a  proper  system  of  expurgation,  lead  to  the  opinion  of  the 
generation  and  existence  there  of  a  morbific  poison. 

13.  The  innocuousness  of  some  marshes,  of  ships  in  a  foul  state, 
or  of  surfaces  bearing  a  strong  resemblance  to  others  in  which 
periodic  fevers  prevail,  is  no  proof  that  exhalations  issuing  from 
sickly  places  or  ships,  are  not  the  cause  of  the  disease ;  for,  besides 
that  the  latter  is  often  traced  to  some  source  of  decomposition  in  a 
way  to  leave  no  doubt  as  to  the  agency  of  these,  the  exemption 


AUTUMNAL   FEVERS.  331 

may  be  justly  attributed  to  the  existence,  in  some  instances,  or  to 
the  absence,  in  others,  of  a  variety  of  necessary  and  concomitant 
circumstances.  Fevers  do  not  prevail  beyond  a  certain  altitudinal 
range;  they  require  a  certain  amount  of  heat,  and  that  this  heat 
should  be  continued  during  a  certain  length  of  time;  they  require, 
besides,  a  certain  amount  of  terrestrial  humidity,  no'more  nor  less ; 
or,  at  least,  that  the  soil  should  have  been  well  saturated  before 
being  exposed  to  the  prolonged  operation  of  the  solar  heat ;  also,  a 
close  and  still  atmosphere,  and  other  contingencies  adverted  to. 
Without  these  they  do  not  appear  to  show  themselves,  how  favour 
able  soever  to  their  generation  may  be  the  condition  and  nature  of 
the  soil  or  the  substances  by  which  it  is  covered  or  permeated. 

14.  The  malarial  doctrine  receives  farther  support  from  the  well- 
attested  fact,  that  the  cause  of  fever  is  carried  by  the  wind  from 
paludal  and  sickly  localities  to  places  situate  at  considerable  dis 
tances;  the  latter  places  remaining  healthy  so  long  as  they  are  to 
windward  of  the  others,  and  becoming  sickly -when  they  are  to  lee 
ward.     In  such  cases,  the  wind  cannot  have  carried  an  amount  of 
heat  or  humidity  sufficiently  different  from  that  existing  before  to 
account  for  the  effect  produced.     Nor  can  it  act  by  occasioning  a 
much   greater   amount  than   usual  of  atmospherical  vicissitudes. 
Hence  the  cause,  to  be  thus  wafted  from  one  place  to  another,  and 
to  give  rise  to  a  particular  disease,  similar  to  that  of  the  locality 
from  whence  it  proceeds,  must  consist  of  a  material  poison,  mixed 
with,  or  suspended  in  the  atmosphere. 

15.  Equally  favourable  to  the  correctness  of  the  belief  is  the 
effect  resulting  from  the  upturning  of  soil  in  hot  weather.     The 
injury  resulting  from  this  operation,  as  illustrated  by  a  wide  dif 
fusion  of  malarial  fevers,  and  the  great  mortality  often  occurring  on 
the  levelling  of  streets,  digging  ditches  and  canals,  cutting  down 
bluffs,  caving  in  of  river  banks,  &c.,  cannot  be  accounted  for  on  the 
principles  advocated  by  the  opponents  of  the  malarial  doctrine,  and 
are  more  easily  explained  on  the  supposition  of  a  poison  exhaled 
from  the  decomposed  organic  matter  contained  in  freshly  exposed 
earth. 

16.  The  effect  of  partial  draining;  of  exposing  a  virgin  soil  to 
the  action  of  the  sun ;  of  the  imperfect  desiccation  of  the  soil  after 
an  overflow,  and  other  kindred  occurrences,  in  producing  or  in 
creasing  fever;   and  the  converse  effect  of  complete  draining,  of 
covering  a  marshy  surface  with  water  or  sand ;  or  masses  of  decaying 


332  PNEUMONIA    AND 

organic  materials,  or  any  other  unhealthy  place,  in  the  same  way, 
or  with  earth,  in  patting  a  stop  to  fever,  lead  to  the  same  con 
clusions. 

17.  Agreeably  to  no  other  doctrine  than  the  malarial,  can  we 
explain  the  greater  sickliness  of  marshes  formed  by  the  mixture  of 
salt  and  fresh  Vater  ;  for  this  mixture  cannot  increase  any  of  those 
influences  to  which   others   attribute    diseases   thus  produced  or 
aggravated ;  while  we  can  understand  that  the  mixture  may  act 
injuriously,  by  furthering  the  decomposition  of  the  organic  matter 
which  it  saturates,  as  well  as  by  the  reciprocal  destructive  action  of 
fresh  water  on  the  living  beings  contained  in  sea-water,  and  re 
versely,  the  destruction  by  the  latter  of  those  contained  in  fresh 
water. 

18.  The  limitation  of  the  disease  to  a  restricted  locality,  to  a  few 
streets  or  buildings,  to  one  house,  or  side  of  a  house,  or  one  room, 
&c.,  bespeaks,  as  do  like  occurrences  on  shipboard,  the  existence  of 
a  local  cause  of  infection,  and  consequently  the  exhalation  from 
this  of  a  morbific  agent. 

19.  The  opinion  of  fever  being  due  to  the  introduction  into 
the   system  of  a   morbid  poison,  floating  in   the  atmosphere    of 
sickly  places,  receives  a  strong  support  from  the  analogy  existing 
between  their  symptoms  and  anatomical  lesions,  and  those  resulting 
from  the  introduction  of  putrid  organic  matter  into  the  circulation, 
or  the  inspiration  of  putrid  vapour. 

20.  The  arresting  or  mitigation  of  fevers  in  sickly  localities  by  a 
resort  to  proper  hygienic  means,  disinfectants,  washing,  excessive 
heat,  &c.,  lead  to  the  same  opinion  ;  for  these  means  operate  in  the 
same  manner  on  other  morbific  causes  the  effluvial  nature  of  which 
is  undoubted,  while  they  have  no  efficiency  in  cases  of  diseases 
arising  from  other  agencies. 

21.  The  effects  of  trees,  walls,  hills,  buildings,  curtains,  &c.,  in 
arresting  the  transit  of  the  cause  of  fevers,  are  equally  favourable 
to  the  idea  of  that  cause  being  a  malarial  poisonous  substance 
contained  in  the  atmosphere. 

22.  Still  more  conclusive  is  the  destruction  of  that  cause  by  frost, 
for  the  latter  cannot  produce  its  beneficial  effects  by  an  action  on 
any  of  the  other  agencies  to  which  fevers  are  ascribed ;  while  it  is 
known  to  exercise  the  same  destructive  influence  over  other  causes, 
of  a  character  similar  to  the  one  from  which  fever  originates. 

23.  The  wide  prevalence  of  autumnal  fevers  in  certain  localities ; 


AUTUMNAL   FEVERS.  333 

the  great  mortality  to  which  they  sometimes  give  rise;  and  the 
diffusion  of  some  forms  of  them  over  a  very  large  expanse  of 
country,  at  a  time,  too,  when  the  sensible  qualities  of  the  atmo 
sphere  do  not  appear  to  have  varied  in  any  important  point  from 
what  they  are  in  healthy  seasons,  afford  an  additional  reason  for 
attributing  them  to  a  toxical  agent  floating  in  the  atmosphere. 

24.  The  transmission  of  the  disease  to  the  foetus  in  utero;  its 
production  from  the  internal  use  of  the  waters  of  marshes ;  the 
inability  of  such  waters  to  sustain  life  in  fish  and  other  animals 
of  the  kind ;  the  undermining  effect  of  a  malarial  atmosphere  on 
the  system ;  the  production  by  it  of  a  state  of  cachexia,  and  its 
influence  in  shortening  the  duration  of  life,  indicate  the  existence 
and  agency  of  a  poisonous  substance  transmissible,  in  the  one  case, 
like  other  morbid  poisons,  by  the  mother  to  the  child  she  bears  in 
her  womb ;  in  another  case  capable  of  solution  in  the  water  which 
helps  to  its  generation ;  and  in  others,  again,  endowed,  like  well- 
known  poisons,  with  the  power  of  gradually  occasioning  peculiar 
and  injurious  changes  in  the  blood  and  vital  organs. 

25.  The  neutralizing  influence  exercised  by  the  poisons  of  some 
zymotic  diseases  over  the  agent  producing  malarial  fevers,  would 
seem  to  indicate  the  existence  of  a  close  analogy  between  the  latter 
and  the  former.     The  same  remarks  are  applicable  to  the  patho 
genic  antagonism  existing  between  malarial  and  typhoid  fevers. 

26.  Lastly,  from  all  that  we  can  gather  respecting  the  origin, 
mode  of  progression,  and  phenomena  of  autumnal  fevers,  the  nature 
of  the  localities  they  visit,  the  circumstances  under  which  they 
appear,  the  agencies  which  promote  their  development,  or  retard 
or  arrest  their  progress,  we  may  conclude,  without  fear  of  error, 
that   everything  tends  to   connect  the   morbific  agent,  of  which 
autumnal  fever  is  the  offspring,  with  the  products  of  the  decompo 
sition  of  organic  materials ;  requiring  as  it  does,  for  its  generation, 
the  action  of  the  very  same  agencies  which  are  necessary  for  that 
decomposition.     Like  the  latter,  it  requires  the  presence  of  the 
above  materials;   like  the  ordinary  decomposition  of  these,  the 
febrile  cause  requires  for  its  generation  a  more  or  less  prolonged 
continuance,  and  a  certain  degree  of  atmospheric  heat ;  it  requires, 
also,  a  certain  amount  of  moisture.    In  the  one  as  well  as  the  other 
process,  an  excess  of  this  moisture  prevents  or  arrests  its  progress ; 
in  the  one  as  well  as  the  other,  a  total  absence  of  the  same  produces 
a  like  preventive  or  destructive  effect.     The  generation  or  diffusion 


334  PNEUMONIA    AND 

of  the  febrile  cause  is  promoted  by  a  calm  and  close  state  of  the 
atmosphere,  and  retarded,  prevented,  or  modified,  by  free  ventila 
tion,  elevated  situations,  and  a  pure  quality  of  the  atmosphere.  Like 
ordinary  decomposition,  the  process  by  which  the  febrile  cause  is 
produced,  is  retarded  by  cold,  and  arrested  by  frost,  as  well  as  by 
intense  heat. 

Now,  as  has  been  said  before,  when  we  find  the  cause  of  fever 
requiring  for  its  development  the  action  of  the  very  agencies  which 
are  necessary  to  insure  the  development  of  the  gaseous  products  of 
decomposition ;  when  we  find  that  without  these  agencies,  applied  in 
certain  proportions,  neither  those  gaseous  products  nor  the  efficient 
cause  of  fever  will  manifest  themselves ;  that  in  all  instances  in 
which  the  latter  is  produced,  as  shown  by  the  occurrence  of  fever, 
materials  capable,  when  acted  upon  by  the  agencies  in  question,  of 
giving  rise  to  the  evolvement  of  the  gaseous  products  of  decompo 
sition — organic  matter  in  various  conditions  and  states  of  modifica 
tion — exists  ;  that  the  total  absence  of  those  materials,  whatsoever 
be  the  degree  of  heat,  and  of  terrestrial  and  atmospheric  moisture, 
carries  along  with  it  an  equal  absence  of  fever ;  and  that,  when 
once  formed,  the  gaseous  products  of  decomposition,  as  well  as  the 
febrific  cause,  are  cut  short  by  frost  or  intense  heat,  and  the  pro 
cess  by  which  they  were  generated  arrested ;  when,  I  repeat,  all 
these  circumstances  are  borne  in  mind,  we  can  have  no  reason  to 
doubt  the  propriety  of  admitting  that  the  febrile  cause  presents 
a  close  analogy  to  the  above-mentioned  gaseous  products;  and  that 
ifr  in  regard  to  the  latter,  heat,  humidity,  and  other  agencies  acting 
in  given  proportions  and  in  concert  on  dead  organic  matter,  give 
rise  to  certain  products  which  assume  the  gaseous  form ;  and  if  the 
process  of  the  generation  of  these,  and  their  existence  in  the  atmo 
sphere  is  destroyed  by  frost  or  intense  heat ;  the  febrile  poison  which 
requires  for  its  generation  the  action  of  the  same  agencies,  as  also 
the  existence  of  a  kindred  matter,  and  is  besides  arrested  in  its 
formation,  and  destroyed  when  formed  in  the  way  mentioned,  must 
necessarily  consist  also  of  some  modification  of  a  similar  kind  of 
gaseous  substance ;  in  other  words,  that  autumnal  fevers  must  be 
the  offspring  of  a  malarial  morbid  poison,  and  not  the  effect  of 
modifications  in  the  sensible  qualities  of  the  atmosphere. 


CHAPTER   Y. 

PNEUMONIA  AND  AUTUMNAL  FEVEK  COMPARED  IN  RE 
FERENCE  TO  THEIR  CAUSES,  MODE  OF  PROGRESSION, 
SYMPTOMS,  ANATOMICAL  CHARACTERS,  AND  THE  CIR 
CUMSTANCES  BY  WHICH  THEY  ARE  INFLUENCED. 

The  causes  of  autumnal  fevers  and  pneumonia  are  different. — In 
the  preceding  chapters,  I  have  endeavoured  to  prove,  by  facts  and 
arguments,  that  autumnal  fevers,  in  their  several  varieties  and 
forms,  from  the  simple  intermittent  to  the  malignant  yellow  fever, 
are  produced  by  specific  toxical  agents,  exhaled  under  the  modi 
fying  action  of  certain  contingent  influences,  heat,  humidity,  &c. 
from  organic  substances  during  the  process  of  decomposition ; 
and  those  agents  I  have,  in  imitation  of  Dr.  Irvine,  who  first 
borrowed  the  term  from  the  Italians,  designated  by  the  generic 
name  of  malaria.  Whether  the  attempt  to  establish,  in  a  satisfac 
tory  manner,  the  correctness  of  this  generally  admitted  but  some 
what  contested  belief  has  been  successful  or  not,  must  be  left  to 
the  decision  of  the  reader.  Convinced,  however,  from  all  I  have 
seen  or  read,  that  the  majority  of  those  who  have  investigated  the 
subject  with  due  accuracy,  learning,  and  impartiality,  will  affirm 
the  conclusions  to  which  I  have  arrived;  unable  to  discern,  in  the 
*  writings  of  the  opponents  of  the  malarial  origin  of  fevers,  anything 
calculated  to  weaken,  in  the  least,  the  force  of  what  has  been 
adduced  in  its  support ;  and  fully  satisfied  that  none  of  the  other 
agencies  to  which  those  diseases  have  been,  at  times,  ascribed,  can 
give  rise  to  their  phenomena,  I  have  no  hesitation  in  regarding 
that  mode  of  origin  as  a  fact  placed  beyond  the  possibility  of  doubt. 

Now,  if  while  entertaining  these  sentiments — while  holding  au 
tumnal  fevers  to  be  the  morbid  products  of  the  poisons  in  ques 
tion — we  lend  a  willing  ear  to  the  speculations  of  those,  who, 
reviving  a  long-exploded  hypothesis,  contend  that  the  same  dele- 


336  PNEUMONIA    AND 

terious  agents  which  produce  fevers  will  also  produce  pneumonic 
inflammation ;  and  if,  from  this  supposed  similarity  of  origin,  we 
argue  that  pneumonia  is  really  and  substantially  nothing  more 
than  a  peculiar  form  of  remittent  and  intermittent  fever,  we  shall 
be  inevitably  led  to  the  conclusion,  that  malarial  exhalations  may 
and  do  give  rise,  in  some  localities,  and  under  certain  circumstances, 
to  inflammation  of  the  lungs.  Nor  is  this  all.  Experience,  as  I 
have  endeavoured  to  demonstrate  in  a  former  chapter,  teaches  that 
pneumonia  occurs,  and  even  prevails  extensively,  under  circum 
stances  when  malaria  cannot,  in  the  most  distant  manner,  be 
suspected  to  have  been  an  efficient  and  necessary  agent  in  its  pro 
duction — as,  for  example,  in  places  where  the  poison  is  not  evolved, 
or,  if  so,  is  harmless ;  or  in  seasons  of  the  year  when,  supposing  it 
to  have  existed  or  produced  its  characteristic  effects  before  it  has 
been  destroyed  through  the  influence  of  frost  or  other  disinfecting 
means.  In  all  such  localities  and  seasons  (as  the  reader  cannot  fail 
to  perceive),  it  follows  that  the  disease,  when  it  occurs,  must  be  due 
to  the  operation  of  morbific  agencies,  different  from  those  to  which 
autumnal  fevers  have  been  distinctly  traced.  The  conclusion  is 
inevitable,  and,  if  while  taking  it  into  consideration,  we  admit  the 
reality  of  the  peculiar  effects  assigned  to  malarial  exhalations — if 
we  consent  to  regard  these  as  prolific  causes  not  only  of  autumnal 
fevers  but  of  pneumonic  inflammation  also — we  shall  be  compelled 
to  recognize  the  possibility  of  the  latter  disease  being,  not  only  in 
different  localities  and  in  different  seasons  of  the  year,  but  every 
where,  and  at  all  times,  the  offspring,  indiscriminately,  of  two  sets 
of  causes,  which,  on  examination,  will  be  found  to  possess  very  dis 
similar  characteristics  and  properties.  Hence,  we  shall  have  the 
rather  anomalous  phenomenon  of  one  and  the  same  disease  some 
times  springing  from  the  operation  of  a  toxical  agent — the  more 
ordinary,  or  indeed  legitimate  effect  of  which  is  the  production  of 
autumnal  fevers — and  at  other  times  resulting  from  morbific  influ 
ences,  which,  whatever  be  the  variety  of  the  diseases  they  really 
produce — a  question  we  have  nothing  to  do  with  at  present — have 
never,  so  far  as  can  be  discovered,  occasioned,  alone  and  unaided 
by  the  former  agent,  an  attack  of  pure  remittent,  intermittent, 
yellow,  or  kindred  fevers.  To  conform  ourselves  to  the  language 
of  our  opponents,  we  shall  have  an  example  of  one  form  of 
periodic  fever,  i.  e.  pneumonia,  produced  by  a  particular  cause — 
malaria — which  gives  rise  also  to  other  forms  assumed  by  that 


AUTUMNAL    FEVEKS.  337 

Protean  disease — remittent,  intermittent,  and  yellow  fevers  ;  while 
in  other  and  more  frequent  instances,  the  aforementioned  form, 
pneumonia,  springs  from  the  action  of  other  and  very  different 
morbid  influences,  prolific  in  inflammations  of  that  sort,  but  differ 
ing  widely  from  malaria  in  this,  that  they  cannot  give  rise  to  the 
fevers  in  question.  In  a  word,  admitting  the  views  referred  to  to 
be  well  founded,  the  so-called  pneumonic  form  of  autumnal  fever 
may  be  produced  by  either  of  two  sets  of  causes;  the  one  of  which, 
at  the  same  time  that  it  occasions  that  effect,  is  ^  the  active  agent  in 
the  production  of  the  more  legitimate  form  of  the  disease  ;  while 
the  latter  form  of  disease — true  autumnal  fever — results  from  the 
operation  of  but  one  of  these  sets  of  causes — malarial  poison — and 
has  never  yet  been  satisfactorily  traced  to  the  baneful  influence  of 
those  other  agents,  which  are  acknowledged  to  produce  the  pneu 
monic  form. 

Now,  it  is  not  presuming  too  much  to  say  that  there  is  not  one 
solitary  case,  authentically  recorded,  and  adduced  by  an  individual 
competent  to  decide  in  matters  of  the  kind,  in  which  genuine  pneu 
monia  can  be  truly  said  to  have  been  produced  solely  by  the  well- 
ascertained  cause  of  autumnal  fever,  and  which  can  thereby  enable 
any  one  to  demonstrate,  in  a  satisfactory  manner,  the  connection, 
as  cause  and  effect,  between  malaria  and  that  disease.  That  a  con 
gested  state  of  the  lining  membrane  of  the  bronchial  tubes,  allied 
to  inflammation,  exists  in  many  cases  during  the  cold  fit  of  an 
ague,  may  be  and  is  doubtless  true.  The  strong,  sonorous  rale, 
which  totally  disappears  on  the  accession  of  perspiration,  indicates 
this  condition,  and  has  been  noticed  too  often  to  be  denied.  There 
may  exist,  also,  during  the  cold  stage,  some  congestion  of  the  lungs, 
which  occasionally  may  approximate  to  the  first  stage  of  pneu 
monia.  But  these  conditions  are  the  effects  of  the  mere  concentra 
tion  of  blood  in  the  internal  organs,  and  occur  in  all  complaints 
attended  with  a  chill.  They  do  not  amount  to  positive  inflamma 
tion;  and,  besides,  do  not  present  themselves  in  other  forms  of 
malarial  fevers  in  which  the  chill  is  feebly  marked  and  not  repeated. 
None,  indeed,  of  the  circumstances  connected  with  the  evolvement 
and  dissemination  of  malaria,  whose  legitimate  effect  is  the  produc 
tion  of  autumnal  and  periodic  fevers  of  various  grades  and  types, 
in  localities  where  the  proper  materials  of  decomposition  exist,  will 
be  found  to  prove  instrumental  in  causing  pneumonia  or  other 
diseases  of  a  kindred  character.  Nor  can  it  be  proper  to  look  to 
22 


338  PNEUMONIA   AND 

the  products  of  such  decomposition  to  account  for  the  occurrence 
of  pulmonary  inflammation  in  malarious  localities  and  seasons, 
unless  we  feel  disposed,  at  the  same  time,  to  ignore,  in  such  places 
and  at  such  periods,  the  morbific  influence  in  the  production  of  the 
disease,  of  the  causes  which  are  acknowledged  to  produce  that  same 
disease  in  situations  where,  and  at  times  when,  malaria  does  not 
and  cannot  be  admitted  to  float  in  the  atmosphere.  In  other  words, 
before  doing  so,  it  will  be  necessary  to  prove  that  in  localities  or 
seasons  noted  for  the  evolvement  of  malaria,  the  ordinary  causes  of 
pneumonia  do  not  prevail,  or,  if  they  do,  remain  perfectly  harmless, 
and  allow  their  rival  in  mischief  to  produce  alone  effects,  to  which, 
under  other  circumstances,  they  themselves  give  rise.  It  is  scarcely 
necessarv  to  remark,  that  there  is  nothing  in  the  atmosphere  of  a 
malarious  locality  capable  of  excluding  the  ordinary  causes  of 
pneumonia;  and  i a  maintaining  that  they  there  assert  their  sway 
as  freely  as  when  the  air  is  not  tainted  by  morbid  effluvia,  we  do 
not  sin  against  the  canons  of  that  system  of  philosophy  on  which 
some  of  our  opponents  lay  so  much  stress.  Now,  if  such  morbid 
influences  exist  as  well  in  malarious  as  in  other  localities ;  if  nothing 
can  be  pointed  out  capable  of  preventing  the  morbid  effects  they 
produce  in  the  latter  from  being  produced  also  in  the  former,  it  is 
certainly  needless  to  have  recourse  to  such  effluvia  for  the  purpose 
of  accounting  for  the  occurrence  of  that  disease ;  for  when  the  latter 
occurs  under  such  circumstances,  it  may  fairly  be  attributed,  not  to 
malaria,  but  to  the  operation  of  its  ordinary  causes.  The  conclu 
sion  will  appear  still  more  natural  when  we  bear  in  mind  a  fact 
already  adverted  to,  that  none  of  the  conditions  of  locality,  which 
are  inimical  to  the  formation  of  malaria,  as  well  as  none  of  the 
hygienic  means  by  which  the  evolvement  of  the  poison  is  arrested 
or  diminished,  have  the  effect  of  preventing  or  lessening  the  pre 
valence  of  pneumonia.  The  disease  continues  to  present  itself  as  if 
no  changes  had  been  made  in  the  surrounding  circumstances,  and 
we  are  justified  in  presuming  that  the  same  causes  which  give 
rise  to  it  after  the  extinction  of  malaria  have  produced  it  before  that 
extinction. 

But  let  us  admit,  for  the  sake  of  argument,  that  in  all  I  have 
advanced  on  this  subject,  I  err.  Let  us  admit  that  sporadic  pul 
monary  inflammation — catarrhal  or  parenchymatous — is  produced 
occasionally,  or  often,  by  the  malarial  poison,  and  that  the  epidemic 
forms  of  the  disease  are  due  to  the  same  cause ;  I  am  not  sure  that 


AUTUMNAL    FEVERS.  339 

the  admission  will  afford  much  help  to  those  who  feel  disposed  to 
argue,  from  this  circumstance,  that  pneumonia  is  only  a  peculiar 
form  of  periodic  fever.  In  the  first  place,  the  conclusion,  if  well 
founded,  would  only  apply  to  those  particular  cases  which  occur 
where  malaria  is  known  to  be  evolved ;  for,  as  we  have  seen,  and 
as  is  acknowledged,  inflammation  of  the  lungs  presents  itself  under 
circumstances  when  it  must  be  due  to  the  operation  of  other  mor 
bific  influences,  and  cannot,  therefore,  be  viewed  as  closely  con 
nected  with  the  fevers  in  question.  In  the  second  place,  whether 
pneumonia  be  produced  by  one  or  the  other  of  the  causes,  from 
the  action  of  which  it  is  well-ascertained  to  originate,  it  is,  to  all 
intents  and  purposes,  the  same  disease;  it  is  simply  pneumonia,  and 
nothing  else.  If  produced  by  malaria,  the  same  thing  would  occur 
— the  morbid  effects  produced  on  the  lungs  would  be  the  same,  as 
if  they  w^ere  the  result  of  any  of  their  ordinary  causes.  The  dis 
ease  would  not  be,  because  thus  produced,  autumnal  fever,  but 
simply  pneumonia.  If  unmixed  with  unusual  morbid  elements,  it 
would  be  governed  by  the  same  laws  as  other  cases;  it  would  be 
recognized  by  the  same  symptoms;  would  present  the  same  ana 
tomical  characters,  and  would  call  for  the  same  treatment ;  while, 
in  cases  presenting  the  unusual  elements  above  alluded  to,  these 
would  constitute  an  addition  to  the  original  elements  of  the  disease, 
by  which  the  latter  would  be  complicated  and  more  or  less  modi 
fied,  without,  however,  being  altered  in  its  essential  characters. 

2.  We  have  seen,  in  a  preceding  chapter,  that  the  prevalence  of 
malarial  fevers,  of  various  grades  and  types,  is  restricted  within 
certain  localities ;  that,  in  many  instances,  the  area  of  these  infected 
places  is  very  limited  in  extent;  that  while  the  disease  prevails  in 
one  spot,  individuals  who  reside  at  a  short  distance,  and  abstain 
from  visiting  that  spot,  escape ;  that  by  removing  from  one  part  of 
the  same  city  to  another  not  far  distant,  or  from  one  end  or  side  of 
a  house  to  another,  or  from  a  lower  to  a  higher  story,  the  disease 
may  be  avoided;  that  ships,  by  shifting  their  position  from  one 
part  of  a  sickly  port  or  shore  to  another  close  by,  are  often  found 
to  lose  the  fever  from  which,  before  the  change,  they  had  suffered 
severely.  We  have  seen,  on  the  other  hand,  that  in  certain  locali 
ties,  the  crexvs  of  vessels  that  had  been  exempt  from  fever  so  long- 
as  they  remained  at  only  a  short  distance  from  land,  were  attacked, 
sometimes  to  a  man,  as  soon  as  they  ventured  ashore ;  and  that 
individuals  who  had  enjoyed  good  health  while  avoiding  infected 


340  PNEUMONIA    AND 

city  or  country  localities,  were  attacked,  with  an  almost  unerring 
certainty,  in  consequence  of  visiting  or  passing  through  them. 
Now  the  physician  who  should  undertake  to  collect  facts  to  prove 
that  the  sphere  of  prevalence  of  pneumonia  is  as  narrowly  circum 
scribed  as  it  is  sometimes  found  to  be  in  fever,  would  have  an 
ungrateful  task  to  perform.  "We  nowhere  hear  of  this  disease 
attacking  a  large  number  of  the  residents  of  a  limited  spot,  of  a 
part  of  a  street  or  house,  and  leaving  every  one  in  the  close  vicinitv 
of  that  spot,  in  the  next  street,  or  in  the  adjoining  houses,  perfectly 
unscathed.  Nor  need  we  fear  to  predict  that  the  medical  writer 
who  ventures  on  the  assertion  that  pneumonia  has  frequently  been 
observed  to  attack  the  occupants  of  the  lower  rooms  of  houses,  or 
the  basement  wards  of  a  hospital,  and  to  scrupulouslv  respect  those 
who  dwell  above ;  that  all  the  inmates  of  one  end  of  an  asylum, 
hospital,  prison,  or  house,  have  been  struck  down  by  inflammation 
of  the  lungs,  while  those  occupying  the  other  parts  of  the  same 
building  have  remained  untouched — and  that,  too,  not  during  one 
season,  but  during  a  succession  of  seasons — will  run  great  risk  of 
giving  but  an  unfavourable  opinion  of  the  authenticity  of  his  facts, 
or  the  soundness  of  his  judgment.  We  do  not  hear  of  the  crews  of 
ships  ridding  themselves  of  the  disease  in  question,  by  shifting  their 
position,  and  anchoring  at  the  distance  of  a  few  dozen  yards ;  or  of 
vessels,  which  before  had  been  healthy,  becoming,  by  a  reverse 
change  or  the  removal  of  an  intervening  ship  or  other  object,  sud 
denly  visited  with  the  disease.  Neither  do  we  find  a  large  number 
of  instances  on  record  of  vessels  which  were  free  so  long  as  they 
remained  under  sail,  or  at  anchor  at  a  short  distance  from  an  in 
fected  shore,  being  filled  with  pneumonic  cases  the  moment  they 
approached  close  to  the  land,  or  sent  their  boats  to  explore  the 
mouths  of  rivers,  &c.;  or,  again,  of  scores  of  individuals,  who  had 
remained  healthy  while  residing  at  a  short  distance,  being  attacked 
with  pleurisy  or  pneumonia  in  consequence  of  jumping  over  the 
barricades,  and  promenading  about  the  streets  of  an  infected  spot. 

3.  It  has  been  seen  that  the  cause  of  autumnal  fever  is  wafted 
by  the  wind ;  that  the  disease  prevails  in  localities  situate  in  such 
a  way  as  to  receive,  through  that  means,  the  malarial  exhalations 
evolved  from  local  sources  of  infection ;  while  other  localities  placed 
in  a  contrary  direction,  though  at  a  very  short  distance,  escape 
more  or  less  completely.  It  has  been  seen,  also,  that  the  effect  does 
not  depend  upon  the  particular  point  of  the  compass,  abstractly 


AUTUMNAL    FEVERS.  341 

considered,  whence  the  wind  happens  to  blow,  but  upon  the  posi 
tion  the  suffering  locality  occupies  relatively  to  marshes  or  other 
sources  of  morbid  effluvia.  Again,  we  have  seen  that  the  disease, 
thus  produced,  will  be  arrested  in,  or  diverted  from,  its  course  by 
a  hill,  a  row  of  trees,  a  wall,  a  curtain,  or  other  such  causes  of  ob 
struction;  and,  on  the  contrary,  that  places  heretofore  healthy  have 
become  infested  with  fever,  by  simply  removing  such  obstructions 
and  allowing  a  free  access  to  some  particular  wind.  The  history  of 
pneumonia  furnishes  us  with  nothing  of  the  kind.  It  presents  no 
example  of  the  disease  being  produced  or  prevented  in  this  way ; 
of  its  causes  being  wafted  by  a  particular  wind  passing  over  an  in 
fected  locality ;  of  its  course  being  impeded  by  hills,  trees,  walls, 
and  curtains ;  or  of  cases  of  it  being  multiplied  by  the  removal  of 
these.  That  cold  winds  will,  as  we  shall  see,  produce,  under  par 
ticular  circumstances,  cases  of  pneumonia,  is  doubtless  true;  but  it 
should  be  borne  in  mind  that  it  matters  not  whether  such  winds, 
in  order  that  they  may  occasion  that  effect,  pass  over  sickly  or 
healthy  localities,  while  their  real  agency  in  the  matter  is  without 
difficulty  accounted  for  by  the  sudden  production  of  one  or  more 
of  the  ordinary  causes  of  the  disease. 

4.  We  have  seen  that   the    overflow  of  the    sea,  of  lakes,  of 
rivers,  or  other  sheets  or  streams  of  water ;  the  establishment  of 
mill-dams ;  the  digging  of  canals ;  the  levelling  of  streets ;  the  partial 
draining  of  marshy  surfaces ;  the  clearing  of  new  land,  and  the  like, 
are  fruitful  sources  of  fevers.    We  have  seen  that  these  are  produced 
by  exhalations  from  masses  of  decaying  or   green  timber,  or  of 
other  vegetable  as  well  as  of  animal  substances,  separate  or  com 
bined,  in  a  state  of  decomposition.     Where,  may  it  not  be  asked, 
shall  we  find  well-authenticated  instances  of  pneumonia  produced 
by  such  occurrences,  unless  they  bring  along  with  them  some  of 
the  ordinary  and  well-known  causes  of  the  disease?     Apart  from 
these  causes  those  occurrences  are  harmless,  so  far  as  thoracic  in 
flammations  are  concerned. 

5.  Facts  in  large  numbers  have  been  adduced  to  show  the  salu 
tary  effects  of  complete  drainage  in  putting  a  stop  to,  or  in  dimi 
nishing,  the  prevalence  of  fevers.    While  such  is  the  constant  result 
of  this  measure  in  regard  to  those  diseases,  no  change  is  effected  so 
far  as  concerns  pneumonia,  which  generally  continues  to  show  itself 
as  if  nothing  had  occurred.     We  have  seen  that  the  same  salutary 
effects,  as  regards  fevers,  have  followed  the  complete  flooding,  by 


342  PNEUMONIA    AND 

artificial  or  natural  means,  or  the  washing  of  insalubrious  localities. 
So  far,  nothing  has  been  pointed  out  calculated  to  show  that  from 
such  occurrences  have  resulted  like  salutary  effects  in  respect  to 
pneumonia,  the  number  of  cases  of  which  does  not  seem  to  be 
smaller  when  the  country  at  large  is  deluged  with  water,  than 
when  it  is  but  partially  covered ;  or  after  a  heretofore  sickly  locality 
has  been  rid,  through  the  effect  of  rain  or  otherwise,  of  all  sources 
of  malarial  exhalations. 

6.  We  have  seen  that  autumnal  fevers,  the  offspring  of  malarial 
exhalations,  prevail  sometimes  to  an  extraordinary  extent  in  certain 
localities,  and  that,  on  particular  occasions,  they  spread  over  a  wide 
expanse  of  country,  striking  down  at  once,  or  in  rapid  succession,  a 
large  portion  of  the  population,  and  causing  among  them  a  consider 
able  mortality.     We  have  seen,  also,  that  while  in  certain  localities 
such  fevers  prevail  extensively,  and  occasion  a  great  loss  of  life,  in 
other  places,  situate  close  by,  and  differing  little  from  the  former 
in  climate,  altitudinal  range,  and  other  particulars,  they  attack  but 
few,  and  give  rise  to  a  small  proportional  mortality ;  that  in  some 
of  the  West  India  Islands,  for  example,  the  deaths  among  the  troops 
have  amounted  to  104.1  per  1,000  (Tobago),  while  in  others  (St. 
Vincent's  and  Barbadoes)  they  have  not  reached  12  per  1,000.     No 
thing  of  the  kind  will  be  found  to  hold  good  as  regards  pneumonia, 
which  in   ordinary  times  is,  comparatively  at  least,   a  disease  of 
unfrequent  occurrence ;  prevails  in  the  same  place  to  very  much 
the  same  extent  at  each  return  of  its  appropriate  season;  or,  if  it 
varies  in  that  respect,  does  so  on  account  of  corresponding  changes 
in  the  sensible  qualities  of  the  atmosphere;  prevails  to  an  equal 
extent  in  each  of  the  several  places  where  fevers  are  so  unequally 
distributed  ;  occasions  everywhere  much  the  same  rate  of  mortality ; 
and,  at  periods  of  its  widest  epidemic  diffusion,  neither  attacks  by 
far  so  large  a  number  of  individuals,  nor  causes  so  immense  a  loss 
of  life,  as  we  find  to  be  the  case  with  regard  to  the  other  disease. 

7.  It  is  a  fact  placed  beyond  doubt,  that  malarial  fevers,  what 
ever  be  the  form  they  assume,  are  more  likely  to  be  the  result  of 
exposure,  in  infected  localities,  to  night  air,  by  which  the  poison 
may  very  naturally  be  understood  to  be  condensed  and  rendered 
more  prolific  of  disease.     During  the  various  epidemics  of  yellow 
fever  in  this  city,  the  baneful  influence  of  night  air  was  manifested 
in  such  innumerable  instances  as  to  leave  no  doubts  on  the  subject 
in  the  minds  of  physicians  conversant  with  the  disease,  by  some  of 


AUTUMNAL    FEVERS.  343 

whom  it  has  been  recorded  in  emphatic  terms.1  Dr.  Merrill,  already 
cited,  in  a  private  communication  to  the  present  writer  says,  in 
reference  to  the  yellow  fever  of  Natchez  :  "I  know  of  no  instance  in 
which  the  disease  was  ever  taken  from  exposure  in  the  daytime,  and 
then  returning  home  to  the  country."  This  only  confirms  an  observa 
tion  very  generally  made  at  every  epidemic  return  of  this  form  of 
fever  in  tropical  and  temperate  climates.  The  same  holds  good  in 
regard  to  remittents  and  intermittents  everywhere,  abroad  or  at  home; 
even  under  circumstances  when  the  greatest  attention  is  paid  to  guard 
against  the  action  of  ordinary  morbific  influences.2  I  am  not  aware 
that  pneumonia,  in  regard  to  the  peculiarities  attending  its  produc 
tion,  is  governed  by  any  law  of  the  kind.  Its  causes  are  operative 
by  day  as  they  are  by  night.  When  proper  precaution  is  taken, 
during  the  latter  period,  to  shield  the  body  from  their  effects,  the 
disease  will  be  easily  avoided.  But  when  the  same  precautions  are 
not  attended  to  during  the  day,  the  disease  is  as  apt  to  follow  then 
as  at  any  other  period.  Even  admitting  this  not  to  be  true,  expe 
rience  teaches  that  night  exposure  is  not  more  dangerous,  so  far  as 
regards  this  disease,  in  a  malarial  than  in  a  non-malarial  locality ; 
the  condition  of  soil,  temperature,  and  other  contingencies  being 
the  same  in  all ;  whereas,  the  contrary  is  the  case  in  reference  to 
autumnal  fevers,  which  follow  on  such  exposure  only  in  certain 
localities. 

8.  Nor  are  we  to  lose  sight  of  the  fact  pointed  out  by  very 
reliable  authorities,  and  which  experience  everywhere  confirms, 
that  the  production  of  fevers  is  favoured  by  the  state  of  sleep. 
Dr.  Eush,  in  his  account  of  the  epidemic  of  1793,  says:  "A  great 
proportion  of  all  who  were  affected  by  this  fever,  were  attacked  in 
the  night.  Sleep  induced  direct  debility  (which  he  afterwards 
called  debility  by  abstraction),  and  thereby  disposed  the  contagion 
(malaria),  which  floated  in.  the  blood,  to  act  with  such  force  upon 
the  system  as  to  destroy  its  equilibrium,  and  thus  produce  a  fever. 
The  influence  of  sleep,  as  a  predisposing  and  exciting  cause,  was 

1  Hush,  Fever  of  1703,  p.  50;  Works,  iv.  18.  85  ;  Deveze,  113, 114;  J.  K.  Mitchell, 
53,  54;   Chapman,  Phil.   Med.  and  Thy*.  J.  via.  319  ;   Emlen,  N.  A.  J.  v.  327;  Cald- 
woll  on  Miasm,  507;   do.  on  Malaria,  128,  144;   Wood,  i.  314. 

2  Grant,  58;  Monltric,  62;  Valentin,  228;  Lempriere,  ii.  113;  Dariste,  218;  Hollo. 
144:   Arnold,  GO;   Celle,  202  ;   Cnillot,  200  ;   Bally,  500 ;   Bryson,  217;  Brocchi,  260 ; 
J.  Johnson  on  Trop.  Cl.  73  ;   Higaiul  do  L'Isle,  in  do.  312;  Gilbert,  81 ;  Barton,  Fev. 
of  Hong-Kong,  Dublin  J.  (X.  S.)  xii.  344-347. 


344:  PNEUMONIA    AND 

often  assisted  by  the  want  of  bedclothes  suited  to  the  midnight  or 
morning  coolness  of  the  air."  That  such  an  agency  has  been  called 
in  question  by  Dr.  Deveze  (114,  llo),  and  others,  is  doubtless  true. 
But  by  reference  to  some  of  the  older  and  many  later  and  contem 
porary  writers,  from  Lancisi  to  the  present  day,  we  shall  find  state 
ments  of  facts  observed  in  Europe,  Asia,  Africa,  and  America, 
which  confirm  the  views  of  our  eminent  countryman.1  Speaking 
of  the  remittent  and  intermittent  fevers  of  Peru,  Ulloa  long  ago 
remarked :  "  Quand  ces  fi^vres  regnent  dans  les  Quebradas  (or  deep 
valleys)  il  suffit  d*y  syourner  pour  en  etre  pris  ;  qu  on  y  dorme  de  nuit  ou 
dejour,  on  ne  les  evite  pas"2  Nor  can  the  effect  be  matter  of  astonish 
ment.  Every  one  knows  that  certain  functions  are  modified  in  a 
more  or  less  marked  degree  by  the  state  of  sleep.  Dr.  Edwards 
has  shown,3  and  the  same  observation  was  made  before  by  Sancto- 
rius  and  Keill,  that  the  state  in  question  has  a  tendency  to  increase 
the  perspirable  process.  At  the  same  time,  the  nervous  energy  is 
diminished,  the  circulation  is  less  rapid,  calorification  is  lessened, 
other  functions  are  performed  with  less  energy,  and  the  whole 
system  is  in  a  state  of  relaxation.  In  a  word,  the  body  is  in  a 
condition  calculated  to  impair  greatly  the  elimination  of  the  malarial 
poison,  and  thereby  favour  its  morbific  impression  on  the  system. 
That  the  state  of  sleep  may,  for  the  same  reason,  render  the  body 
more  susceptible  to  the  action  of  other  morbid  agencies — even  of 
those  which  give  rise  to  pneumonia — and  that  hence  the  attack,  in 
some  instances,  may  have  been  due  to  exposure  to  cold  during  that 
state,  no  one  is  justified  in  denying.  But  such  cases  are  compara 
tively  seldom  encountered;  and  in  fenny  districts  or  infected 
localities,  persons  who  fall  asleep  in  the  open  air  at  night,  during 
the  sickly  season,  are  not  more  than  ordinarily  liable  to  attacks  of 
pneumonia,  or  at  any  rate  not  more  so  than  if  no  cause  of  infection 
existed;  while  in  other  localities,  during  corresponding  seasons, 
but  where  such  causes  do  not  exist,  sleeping  in  the  night  air  may  not 

1  Lancisi,  op.  cit.  77;  Bancroft,  86,  87,  100,  172;   Lind  on  Seamen,  75  ;  II.  on  Hot 
Cl.  192,  233;   Wood,  i.  144;   Simons,  18;   Bryson,  218;  Wallace,  Edinb.  J.  xlvi.  273; 
Monfalcon,  196;  Alibcrt.  235;   Folchi,  N.  A.  J.  vii.  258;   Clark's  Notes  on  Italy,  10; 
Blanc  on  Seamen,  230;   Edinb.  Rev.  xxxvi.  546;   Cclle,  prat,  des  Pays  Chauds,  298; 
Watson,  Tract.  450  ;   Brocchi,  Stato  Fisico  de  Roma. 

2  Ulloa,   Mcmoires  Philosopbiques  Hist    Physiques  concernent   la  Decouverte  de 
1'Amcrique,  i.  245. 

3  On  Physical  Agents,  102,  Am.  ed. 


AUTUMNAL    FEVERS.  345 

be  indulged  in  with  impunity  unless  the  same  precautions  are  used 
as  would  be  necessary  in  the  daytime. 

9.  We  have   seen  that  the  development  of  fever  may  be  pre 
vented,  and  its  progress  arrested,  by  the  judicious  use   of  disin 
fectants — by  smoke,  the  sprinkling  of  lime,  the  lighting  of  fires; 
by  the  clearing  and  washing  of  gutters,  sinks,  and  sewers  ;  by  the 
removal  or  covering  over  of  sources  of  infection.     No  such  means 
have  ever,  to  my  knowledge,  prevented  the  development  or  arrested 
the  progress  of  pneumonic  inflammation,  among  the  inhabitants  of 
any  locality,  large  or  small.     To  this,  let  me  add  that  in  malarial 
localities,  where  fevers  are  rife,  and  exposure  early  in  the  morning 
is  almost  sure  to  be  followed  by  an  attack,  it  has  been  found  useful 
to  avoid  going  out  on  an  empty  stomach  or  without  taking  a  small 
quantity  of  ardent  spirits,  or  a  cup  of  hot  coffee.     From  this  has 
doubtless  arisen  the  custom,  so  prevalent  in  some  parts  of  tropical 
countries — in  Martinique,   Guadalonpe,   Guiana,  Cayenne,  &c. — of 
taking  a  cup  of  strong  infusion  of  the  latter  on  rising  in  the  morn 
ing.      Ity  means  of  this  substance,  the  bitter  principle  of  which 
bears  some  analogy  to  that  of  cinchona,  intermittent  fevers,  as  we 
learn  from  Moreau  de  Jonnes,  are  frequently  prevented.   The  same 
effect  is  obtained  by  bark  itself,  or  some  of  its  salts  taken  in  the 
same  way.     When  the  French  army  encamped  in  the  morasses  of 
Mantua,  the  soldiers  were  all  made  to  take,  at  the  dawn  of  day,  a 
portion  of  tincture  of  bark,  and  from  this  precautionary  measure, 
which  was  long  ago  recommended  by  Lind  and  other  writers,  the 
most  beneficial  results  were  obtained.1    These  precautions  will  serve 
very  little  purpose  against  pneumonia. 

10.  We  have  seen  that  fevers  are  in  very  many  instances  the 
result  of  a  solitary  and  transient  exposure  to  an  infected  locality ; 
indeed,  that  the  large  majority  of  those  who  thus  expose  them 
selves,  run  an  imminent  risk  of  an  attack.   In  regard  to  pneumonia, 
not  one  probably  in  thousands  would  be  in  danger  from  such  ex 
posure  in  any  locality ;  and  in  those  so  attacked,  after  a  visit  to  an 
infected  spot,  the  disease  would  easily  be  traced  to   a  disregard  of 
precautionary  measures  absolutely  necessary  everywhere  to  guard 
against  the  disease,  and  which  have  no  connection  whatsoever  with 

1  Blane,  Dissertations,  i.  221  ;  Bryson,  227;  Aubert  Roche,  Mem.  sur  I'Acclimate- 
ment,  An.  d'Hyg.  xxxiii.  23  ;  Monfalcon,  op.  cit.  232  ;  Celle,  Hygiene  des  Pays  Chaucls, 
347,  367  ;  Moreau  de  Jonnes,  Hygiene  Militaire  des  Antilles,  07  ;  Lind  on  Hot  Climates, 
317,  318;  Thevenot,  05;  Cuillot,  264;  Hollo,  147. 


346  PNEUMONIA   AND 

the  special  causes  of  autumnal  fevers,  while  the  danger  would  not 
be  greater  in  sickly  localities  than  elsewhere. 

11.  It  has  been  stated,  on  respectable  authority,  that  in  both  the 
West  and  East  Indies,  places  where  the  mangrove  and  mancinellas 
grow  luxuriantly,  the  most  unhealthy  spots  are  those  in  which  the 
roots  of  those  plants  are  only   occasionally  and  partially  under 
water ;  and  that  in  tropical  climates  the  existence  of  a  large  quan 
tity  of  astringent  plants,  the  bark  of  which  is  rich  in  animal  matter 
combined  with  tannin,  is  generally  connected  with  the  development 
of  fever.     What  reason  have  we  for  believing  that  these  circum 
stances  exercise  an  influence  on  the  development  of  pneumonia  ? 

12.  Epidemics  of  fever  are  on  very  many  occasions  attended 
with  a  wide-spread  disturbance  in  the  health  of  the  population  at 
large — a  considerable  number  of  individuals,  though  not  labouring 
under  the  fully-formed  disease,  exhibiting  one  or  more  of  its  symp 
toms  in  a  mitigated  form,  and  bearing  the  marks  of  the  cause  hav 
ing  produced  an  impress  on  the  system,  as  shown  by  the  condition 
of  the  eyes,  the  secretions,  the  alimentary   canal,   the  brain   and 
nerves,  the  blood,  &c.     AVe  do  not  find  such  a  result  to  obtain 
during  seasons  when  pneumonia  is  most  prevalent. 

13.  Neither  do  we  find  that  in  those  seasons  the  lower  orders  of 
animals  or  plants  suffer  in  a  way  corresponding  to  that  they  are 
often  found  to  suffer  in  times  of  fever  epidemics. 

In  fine,  the  more  we  examine  the  question  at  present  before  us, 
the  more  inclined  we  must  be  to  adopt  the  opinion,  that  pneumonia 
is  never  produced  simply  by  the  introduction  into  the  system  of  a 
malarial  poison  by  which  the  atmosphere  of  an  infected  locality  is 
polluted;  for,  when  the  disease  attacks  individuals  exposed  to  the 
influence  of  such  places,  it  may  be  traced  to  the  operation  of  other 
agencies,  which  prevail  contemporaneously  with  the  poison  in  ques 
tion,  and  cannot  fail  to  exercise  their  baneful  effects  in  an  impure, 
as  they  do  in  a  pure  locality.  Nor  can  we  greatly  err,  when  we 
affirm  that  if  those  agents  produce  pneumonia  in  places  where  the, 
malarial  influence  does  not  extend,  where  malaria  is  never  evolved, 
or  where  its  evolution,  if  it  has  taken  place,  has  been  completely 
arrested,  as  proved  by  the  constant  absence  or  cessation  of  its  legi 
timate  effects — fevers — it  is  to  them  we  must  look  for  the  true 
cause  of  the  development  of  the  disease  when  it  shows  itself  in 
infected  localities,  and  not  to  the  exhalations  by  which  the  atmo 
sphere  of  those  localities  may  be  contaminated.  So  long  as  care  is 


AUTUMNAL   FEVERS.  347 

taken  to  avoid  the  action  of  those  agencies,  exposure  to  malaria 
may  produce  fevers ;  but  no  quantity  of  it  received  into  the  system 
will  occasion  pneumonia,  which,  in  fever  localities  as  elsewhere, 
owes  its  origin  to  the  operation  of  the  same  causes. 

Causes  of  Pneumonia. —  As  regards  the  nature  of  the  morbific 
influences  in  question,  it  will  not  be  necessary  to  say  much  in  this 
place.  Every  one  conversant  with  the  subject,  whether  in  or  out 
of  the  profession,  knows  full  well,  that  pneumonia  and  all  other 
kindred  affections  of  the  thoracic  organs,  are  very  usually  due,  not 
in  one  place  and  in  one  season  only,  bat  in  all  places  and  at  all 
times,  to  atmospheric  vicissitudes,  to  exposure  to  cold,  especially 
when  the  body  is  hot  and  perspiring,  to  currents  of  cold  air,  and  the 
like.1  Dr.  Barton,  of  New  Orleans,  who  has  paid  much  attention 
to  meteorological  subjects,  informs  me,  in  a  private  communication, 
that  "Pneumonia  is  most  apt  to  occur  at  variable  temperatures 
from  20  to  50 — with  a  low  dew-point,  and  great  drying  power, 
producing  rapid  evaporation  from  the  surface  of  the  lungs  and 
skin."  Add  to  these  sundry  physical  and  local  causes — violent 
exercises  of  the  voice,  irritating  vapours,  and  asphyxiating  gases, 
blows  on  the  chest,  wounds  of  the  lungs ;  the  translation  by  meta 
stasis  of  gout,  rheumatism,  cutaneous  diseases ;  the  transfer  of 
inflammation  or  purulent  deposits  after  extensive  wounds  in  vari 
ous  parts  of  the  body,  or  important  surgical  operations.2  Expe 
rience  teaches  all  this;  and  teaches,  besides,  that  the  prevalence  of 
pneumonic  inflammation  in  each  system  of  climate  increases  and 
decreases  in  proportion,  not  as  the  evolution  of  malaria  increases  or 
decreases,  but  as  the  seasons  are  contrasted ;  thus  maintaining,  as 
Dr.  Forry  has  correctly  pointed  out,  an  unvarying  relation  with  the 
extreme  range  of  the  thermometer  as  connected  with  the  seasons. 
In  other  words,  we  find  that  the  ratio  of  those  diseases  is  highest  in 
proportion  as  the  difference  between  the  temperature  of  summer 

1  Plildebrand,  Inst.  Pract.  Med.  iii.  194;  Bouillaucl,  Diet,  de  Med.  Pract.  xiii.  359; 
Ib.  Med.  din.  ii.  151  ;  Grisolle,  147  ;  Swett.  80,  81 ;  Williams,  Cycl.  of  Pract,  Med.  iii. 
407;  Chomel,  Diet,  de  Mod.  xxv.  1G4;  Andral,  Med.  Clin.  i.  512;  Barthez  et  Rilliet,  i. 
115;    Pinel   &  Brichetau,   Diet,   des  Sc.   M&l.  xliii.   396;    Laennee,  i.  546;  Forbes's 
Transl.  225 ;  Daniel  Monro,  ii.  247  :  W.  Phillip,  204 ;  Wood's  Pract.  ii.  42. 

2  See  Sir  C.  Bell's  Surg.  Operations;  Guthrie  on  Gunshot  Wounds;   Forbes's  Laen 
nee  ;  'Williams,  Cyclopedia;  Grisolle,  142:  Rouppe,  44;   J.  Frank,  810  :   Lieutaud,  i.  ; 
Portal,  Auat.  Med.  v.  72:  Andral,  Clinical  Med,  i,  512;  Erichsen,  Mcd.-Ch,  Trans, 
xxvi.  2!l 


348  PNEUMONIA    AND 

and  winter  increases,  and  lowest  in  proportion  as  it  grows  less; 
that  the  stronger  the  impression  on  the  system  by  the  high  tempe 
rature  of  the  former  season,  the  more  susceptible  the  lungs  are  ren 
dered,  so  far  as  regards  inflammatory  complaints,  to  the  morbific 
agency  of  the  opposite  seasons ;  that  those  diseases  are  invariably 
less  prevalent  in  the  moist  and  changeable  climate  peculiar  to  the 
sea-coast  and  large  lakes  of  this  country,  where  malaria  is  abund 
antly  evolved,  than  in  the  dry  atmosphere  of  the  opposite  locality, 
where  the  febrile  poison  is  not  largely  produced.  Hence,  if  pneu 
monia  and  pleurisy  are  more  frequently  encountered  in  the  Middle 
and  Southwest  regions  of  the  United  States  than  in  the  cold  and 
variable  climates  of  our  Northern  and  Eastern  States,  the  explana 
tion  is  not  to  be  sought  in  the  fact,  that  the  cause  of  periodical  or 
autumnal  fevers  exist  in  many  sections  of  those  regions,  but  in  the 
circumstance  that  individuals  are  placed  under  the  control  of  the 
law  above  alluded  to ;  i.  e.  the  greater  impressibility  of  the  thoracic 
organs  to  cold  occasioned  by  the  previous  influence  exercised  by 
long-continued  summer  heat;  and  that  the  effect  is  equally  well 
marked,  whether  the  locality  where  these  diseases  are  found,  be  or 
be  not  the  seat  of  febrile  affections,  or  characterized  by  the  kind  of 
soil  prone  to  the  production  of  the  latter ;  and  are  likewise  noticed 
in  climates  where,  from  the  peculiarities  of  the  soil,  the  nature  and 
proportionate  duration  of  the  seasons,  and  the  range  of  the  thermo 
meter  and  hygrometer,  they  never  have  originated,  and  in  all 
probability  never  can  originate. 

Another  writer,  who  has  investigated  the  subject  on  even  a 
larger  scale  than  Dr.  Forry — Dr.  Lawson,  of  the  English  army,  and 
whose  conclusions  are  drawn  from  the  results  obtained  among  the 
British  troops  in  the  different  stations  scattered  over  the  greater 
part  of  the  earth,  remarks,  that  the  frequency  of  inflammatory  dis 
eases  of  the  lungs,  and  the  amount  of  the  resulting  mortality,  are 
proportional  to  the  prevalence  and  activity  of  the  (not  malarial 
poison,  but)  refrigerating  causes  relatively  to  the  powers  of  resist 
ance  of  the  constitution.1 

Not  very  different  is  it  in  relation  to  catarrhal  complaints,  which, 
as  we  have  seen,  Dr.  Copland  and  others  have  classed  among  the 
products  of  malaria.  Except,  perhaps,  when  it  presents  itself  in  the 
garb  of  what  lias  been  denominated  influenza — and  then  it  is  appa- 

1  Ediub.  Med.  and  Surg  J.  Ixii.  50. 


AUTUMNAL   FEVERS.  349 

rently  due  to  some  wide-spread  and  travelling  meteorological  change, 
of  the  essence  of  which  we  know  nothing,  but  certainly  bearing  no 
analogy  to  miasmal  exhalation — catarrh  is  evidently  the  offspring 
of  those  atmospheric  influences  to  which  other  thoracic  irritations 
are  due;  while  the  idea  of  its  dependence  on  the  specific  cause  of 
periodic  fevers  will  be  found  destitute  of  solid  foundation.  On  this 
subject  let  the  following  remarks  of  Dr.  Forry  suffice  : — 

"  That  catarrhal  fever  has  not  the  remotest  connection  with  ma 
larial  causes,  is  demonstrated  by  the  statistics  of  our  troops.  As 
the  ratio  of  intermittent  and  remittent  fever  is  about  five  times 
higher  in  our  southern  than  northern  latitudes,  and  as  that  of 
catarrhal  affections  is  twice  as  high  in  the  latter,  it  follows  that,  as 
the  results  are  in  an  inverse  proportion,  no  relation  of  cause  and 
effect 'is  discoverable.  As  the  classification  of  Dr.  Copland,  how 
ever,  limits  the  production  of  catarrhal  fever  to  '  temperate  ranges 
of  atmospheric  heat,  aided  by  moisture,'  it  may  be  said  that  it  ap 
plies  only  to  our  northern  regions.  In  diametrical  opposition,  then, 
to  this  view,  it  is  found  that  in  the  winter,  when  no  '  miasm  from 
decayed  vegetable  matter  arises,  the  ratio  is  twice  as  high  as  in 
summer,  and  that  the  annual  ratio  in  the  moist  climate  of  the  lakes, 
and  the  coast  of  New  England,  is  not  more  than  half  as  high  as  that 
of  the  dry  climate  of  the  region  remote  from  large  bodies  of 
water.'"1 

All  this,  let  it  be  said  en  passant,  differs  somewhat  from  the  re 
sults  obtained  in  regard  to  autumnal  fevers,  which,  in  temperate 
regions,  where  the  temperature  of  the  several  seasons  are  generally 
strongly  contrasted,  often  prevail  most  when  a  very  long  hot  sum 
mer  succeeds  to  a  very  cold  winter;  and  which,  on  the  other  hand, 
spread  more  extensively  in  tropical  regions  and  in  the  southern 
regions  of  this  country  and  Europe,  where  the  seasons  are  not  con 
trasted,  or  are  so  to  a  limited  extent,  and  which  require  for  their 
development  and  dissemination  meteorological  conditions,  for  the 
most  part  the  reverse  of  those  mentioned  in  regard  to  pneumonia. 

But  be  this  as  it  may,  the  experience  of  the  world  shows  that 
although  it  is  not  always  possible,  in  all  individual  cases  of  pneu 
monia,  and  under  all  circumstances,  to  arrive  at  a  precise  knowledge 
of  the  cause  of  the  disease,  owing  to  the  difficulty  of  obtaining  defi 
nite  and  correct  information  from  those  attacked,  or  from  the  indis- 

1  Climate  of  the  U.  S.  305. 


350  PNEUMONIA    AND 

tinct  manner  in  which  the  morbid  agent  has  impressed  the  s}rstem; 
yet,  in  the  larger  number  of  instances,  the  disease  is  due  to  well- 
ascertained  injurious  influences,  not  one  of  which  can  produce,  or 
has  ever  produced,  intermittent,  remittent,  bilious,  or  yellow  fevers, 
or  bears  the  least  analogy  to  the  morbid  poisons  which  give  rise  to 
these  maladies.  And  it  is  not  a  very  great  stretch  of  assumption 
to  suggest,  that  in  those  instances  in  which  the  cause  cannot  be 
satisfactorily  ascertained,  it  would,  if  discovered,  be  found  to  be 
allied  to  the  former  influences,  and  to  have  nothing  in  common  with 
the  latter.  True  it  is  that  writers  have  speculated  on  the  possibility 
of  inflammatory  affections  of  the  lungs  being,  under  particular  cir 
cumstances,  produced  by  the  introduction  of  certain  morbid  poisons 
into  the  circulation,  through  the  agency  of  respiration  or  otherwise ; 
and  it  may  be  argued  that,  if  we  admit  this  to  be  the  case  in  some 
instances,  the  advocates  of  the  malarial  origin  of  pneumonia  will 
think  themselves  justified  in  maintaining,  that  what  is  true  of  one 
or  more  poisons,  may  be  supposed  to  hold  equally  good  in  regard  to 
the  cause  of  autumnal  fevers.  Such,  for  example,  has  been  said  to 
be  the  effect  of  the  poison  of  the  rattlesnake,  which,  it  is  affirmed, 
gives  rise  to  pneumonia;  and  we  know  that  epidemic  catarrh  or 
influenza,  in  which  the  disease  extends  sometimes  to  the  substance 
of  the  lungs,  as  well  as  epidemic  pneumonia,  are  supposed  by 
respectable  authorities — among  whom,  in  reference  to  the  latter 
complaint,  we  find  no  less  a  name  than  that  of  Laennec1 — to  be  due 
to  a  peculiar  miasm  floating  in  the  atmosphere ;  the  reason  assigned 
being  the  universality  of  the  prevalence  of  those  affections,  and  the 
difficulty  of  tracing  them  to  any  of  their  ordinary  causes.  In  all 
this,  however,'  we  can  discover  nothing  more  than  conjecture.  In 
the  first  place,  the  statement  respecting  the  agency  of  the  poison -of 
the  rattlesnake  in  producing  pneumonia,  to  say  the  least,  needs 
confirmation.  By  those  most  experienced  in  the  matter,  it  is  statod 
that  when  a  rabbit  or  small  animal  is  poisoned  by  this  snake,  it 
gives  no  evidence  of  feeling  pain,  and  generally  for  some  minutes 
appears  to  be  well — his  ears  then  begin  to  droop,  giddiness  and 
uneasiness  follow,  and  the  animal  falls;  the  pupil  becomes  dilated, 
slight  convulsions  ensue,  and  death  closes  the  scene  in  about  fifteen 
minutes  from  the  accident.  On  examination,  it  is  found  that  tin* 
red  colour  of  the  blood  in  the  part  affected  has  been  d-jstrnyo-l. 

1  Traite  de  1'Auscultation,  i.  547. 


AUTUMNAL    FEVERS.  351 

The  muscular  fibres  and  cellular  substance  for  two  inches  around 
the  puncture  are  black,  and  so  is  the  blood  in  the  veins  leading 
from  the  wound ;  that  in  the  heart  is  darker  than  natural,  and  does 
not  coagulate  so  firmly  as  when  the  animal  has  been  killed  by  a 
blow  on  the  head ;  the  supply  of  blood  to  the  brain  is  deficient;  but 
neither  this  organ  nor  any  other  solid  parts  show  signs  of  injury, 
except  near  the  wound,  which  swells  sometimes  very  considerably.1 
In  man,  the  symptoms  are  longer  in  developing  themselves,  and 
the  disease  runs  a  more  protracted  course ;  but  the  phenomena  are 
similar  in  kind,  and  in  no  instance  evince  anything  indicating  the 
existence  of  pneumonic  inflammation.  If  pulmonary  symptoms 
occur,  and  the  lungs  are  found  to  present,  after  death,  marks  of 
morbid  change,  the  effects  are  due,  in  this  and  other  kindred  cases, 
to  simple  congestion,  a  condition  very  generally  encountered  in 
affections  characterized  by,  or  combined  with  a  defibrinated  state 
of  the  blood.2 

Again ;  of  the  morbific  agent  which  gives  rise  to  influenza  we 
know  little.  Indeed,  if  we  knew  more,  it  is  not  certain  that  our 
information  would  lead  to  anything  of  much  importance  relative  to 
the  present  inquiry ;  inasmuch  as  that  agent,  whatsoever  be  its  na 
ture,  affects  primarily  the  mucous  tissue  of  the  lungs ;  and  pneu 
monia,  when  it  occurs,  is  only  consecutive,  and  not  the  direct  effect 
of  the  cause  producing  the  primary  disease.  Moreover,  in  regard 
to  epidemic  pneumonia,  nothing  as  yet  adduced  proves  its  malarial 
origin.  If  sporadic  cases  of  pulmonic  inflammation  can  and  do  arise 
from  the  operation  of  causes  totally  unconnected  with  the  existence 
and  evolution  of  miasmal  exhalations,  there  is  no  reason  why  the 
epidemic  form  of  the  disease  should  not  be  assigned  to  the  same  or 
similar  agencies  acting  more  extensively,  in  consequence  of  a  uni 
versal  state  of  predisposition  brought  about  by  a  peculiar,  insensible, 
and  unfathomable  condition  of  the  atmosphere.  The  diffusion  of  the 
disease  over  large  tracts  of  country ;  its  prevalence  at  diversified  sea 
sons  of  the  year,  under  diversified  conditions  of  the  sensible  qualities 
of  the  atmosphere;  its  visiting  with  equal  force  localities  of  different 
or  even  opposite  characters  and  conditions ;  its  appearing,  even  at 
sea,  far  beyond  the  reach  of  any  possible  source  of  exhalation ;  are 
inimical  to  the  theory  of  its  miasmal  origin;  while  the  argument 

1  Stevens  on  the  Blood,  138. 

2  See  a  communication  on   "  The  Bites  of  Venomous  Serpents,"  by  Dr.  E.  Hallo- 
well,  in  Trans,  of  Thilad.  Col.  of  Phys.  i.  N.  S.  394. 


352  PNEUMONIA    AND 

derived  from  the  circumstance  of  the  impossibility  of  discovering 
an  evident  cause  to  account  for  epidemic  pneumonia  is  met  by  the 
fact  already  referred  to,  that  sporadic  cases,  which  it  would  be  next 
to  an  absurdity  to  attribute  to  malaria,  spring  up  without  its  being 
possible  to  trace  them  to  any  evident  cause.  At  any  rate,  if  the 
morbid  agent  giving  rise  to  this  and  the  preceding  form  of  disease 
must  really  be  viewed  as  nothing  more  than  a  species  of  malaria, 
that  malaria  can  bear  no  analogy  to  the  one  producing  autumnal 
fever.  More  likely  is  it  that  the  cause  of  diffusion  of  the  disease  is 
meteorological,  and  assimilable  to  the  terrestrial  fluids  of  electricity 
and  magnetism,  and  that  its  operation  is  limited  to  predisposing  the 
system  to  be  acted  upon  by  other  agencies. 

Dr.  Merrill,  to  whose  Essay  attention  has  been,  especially  called, 
disclaims,  as  we  have  seen,  the  disposition  to  deny  that  pneumonia 
sometimes  appears  as  an  idiopathic  affection — a  form  of  the  disease 
which  he  seems  never  to  have  encountered  in  his  practice,  and  only 
admits,  because,  to  use  his  own  language,  such  is  the  result  of  ob 
servations  made  by  others,  who  are  certainly  not  less  qualified  to 
form  a  correct  judgment  in  the  premises.  Even  while  upholding 
his  favourite  theory  respecting  the  supposed  connection  between 
that  disease  and  periodic  fever,  he  regards  the  former,  wheresoever  it 
may  appear,  and  whatsoever  form  it  may  assume,  as  being  excited 
into  action,  or,  in  other  words,  as  requiring  for  its  development,  the 
agency  of  the  sudden  transitions  of  temperature  which  occur  on  the 
approach  of  winter.  Entertaining  such  views  on  these  subjects; 
recognizing  as  a  well-established  fact  the  existence  of  an  idiopathic 
form  of  the  disease,  distinct  from  that  which  he  supposes  prevails 
most  generally — sometimes  sporadically  and  frequently  as  an  epi 
demic — he  will  not  refuse  to  acknowledge  what,  indeed,  as  we  have 
seen,  experience  establishes  beyond  the  possibility  of  doubt,  that  in 
northern  latitudes  and  in  elevated  situations,  where  malarial  fevers 
do  not  occur  at  all,  or,  if  they  do,  show  themselves  only  during  a 
limited  portion  of  the  year,  and  are  cut  short  by  the  intervention  of 
frost ;  where,  therefore,  the  cause  producing  them  is  never  evolved, 
or,  being  so,  is  destroyed  on  the  approach  of  winter ;  and  where,  as 
a  consequence,  pneumonia  cannot  be  regarded  as  the  offspring  of 
that  cause; — this  disease,  which  prevails  in  such  localities  at  all  sea 
sons  of  the  year,  and  is  more  particularly  rile  under  circumstances 
perfectly  incompatible  with  the  development  of  febrile  diseases, 
must  necessarily  be  referred  to  the  atmospheric  influences  above 


AUTUMNAL    FEVERS.  353 

enumerated.  We  must  presume,  also,  that  lie  will  not  refuse  to 
regard  the  idiopathic  form  of  pneumonia,  when  it  occurs  in  truly 
miasmatic  regions,  whether  in  the  south,  the  north,  the  east,  or  the 
west,  as  the  offspring  of  a  cause  differing  from  that  giving  rise  to 
periodic  fevers,  and  with  these  to  that  form  of  the  disease  which  he 
views  as  closely  connected  or  identical  with  the  latter ;  which  cause 
cannot  be  other  than  the  atmospheric  influences  which,  as  we  have 
seen,  produce  inflammation  of  the  lungs  elsewhere,  and,  according 
to  his  own  saying,  is  necessary  to  excite  into  being  the  sympto 
matic  form.  The  inference  is  inevitable ;  for,  were  the  cause  not 
acknowledged  to  be  of  a  different  character,  there  would  be  no 
ground  upon  which  to  establish  the  distinction  between  an  idiopa 
thic  and  a  symptomatic  form  of  pneumonia. 

Now,  if  the  disease  is  thus  viewed  as  arising  from  the  agency  of  a 
distinct  cause — often  in  these  and  in  northern  latitudes,  and  some 
times  in  the  south  and  malarial  districts  generally;  if,  at  the  same 
time,  it  is  acknowledged  (if  not  in  actual  words,  at  least  by  implica 
tion)  that,  were  it  not  for  this  cause — i.  e.  the  sudden  transitions  of 
temperature  which  occur  at  the  approach  of  winter — the  thoracic 
viscera  would  not,  even  in  the  symptomatic  form  of  the  disease, 
be  called  upon  to  bear  the  burden  of  local  disease,  and  would  escape 
risk  of  inflammation;  and  if,  besides,  while  such  views  are  expressed, 
we  are  told  that  "  the  pneumonias  which  prevail  in  this  country 
generally — sometimes  sporadically  and  frequently  as  an  epidemic 
— are  really  and  substantially  nothing  more  than  a  peculiar  form 
6f  remittent  and  intermittent  fevers,"  it  must  follow  that  such 
pneumonias  are  the  result  of  the  cause  which  produces  these 
fevers,  and  which  we  may  presume  Dr.  Merrill  regards  as  different 
from  that  giving  rise  to  what  he  holds  to  be  the  idiopathic  form 
of  the  disease.  Here,  then,  we  find  the  same  causes — atmospheric 
influences — officiating  in  some  cases  as  the  efficient  and  sine  qua 
non  agents  in  the  production  of  the  disease,  and  in  others  acting 
simply  by  promoting  the  development  of  the  disease,  the  founda 
tion  of  which  had  been  laid  by  another  and  very  different  patho 
genic  influence.  But,  more  than  this ;  we  find  the  same  disease — 
for  we  are  not  informed  of  the  existence  of  any  symptomatological 
or  pathological  difference  between  the  two  supposed  forms  of 
pneumonia — ascribed,  as  already  mentioned,  to  two  distinct  classes 
of  causes  ;  atmospheric  vicissitudes  on  the  one  hand,  and  the  pecu 
liar  agent,  whatever  this  may  be,  which  gives  rise  to  periodic  fever, 
23 


354  PNEUMONIA   AND 

on  the  other.  The  reader  can  scarcely  fail  to  see  that  this  mode 
of  proceeding  does  not  accord  with  the  canon  laws  of  that  system 
of  philosophy  of  which  we  hear  so  much,  and  by  which  it  is  to 
be  hoped  all  medical  inquirers  are  guided;  for  that  philosophy 
teaches  the  impropriety  of  referring  a  specific  effect  to  more  than 
one  cause.  In  the  present  instance,  it  would  lead  us  to  conclude 
that,  since  the  idiopathic  pneumonia  of  the  south  is  admitted  to 
arise  from  causes  distinct  from  those  that  produce  periodic  or 
autumnal  fever;  since  the  same  disease  undoubtedly  arises  very 
frequently,  not  to  say  universally,  from  such  causes  in  the  north 
and  elsewhere;  and  since,  in  the  south,  the  agency  of  the  former  is 
essential  to  its  manifestation,  even  when  the  causes  of  fevers  are 
supposed  to  be  instrumental  in  its  production,  there  can  be  no  rea 
son  for  attributing  pulmonary  inflammation,  when  it  appears  in  the 
southern  section  of  this  country,  any  more  than  when  it  shows 
itself  in  northern  latitudes  and  in  elevated  positions,  where  autumnal 
fevers  do  not  extend  their  sway,  to  a  different  morbific  agent. 
Everywhere  the  same  cause  must  produce  the  same  effect,  and  a 
different  effect  must  be  produced  by  a  different  cause.  Everywhere, 
therefore,  the  disease  must  arise  from  the  same  modifying  agencies; 
and  hence,  if  in  some  places  it  is  due  to  atmospheric  influences, 
there  can  be  no  propriety  in  lending  our  support  to  the  idea  that 
it  arises  elsewhere  from  the  operation  of  agencies  of  a  different 
kind.  In  other  words,  we  must  discard  the  theory  which  teaches 
that  in  the  same  place  the  disease  occurs  sometimes  from  the  influ 
ence  of  one  cause,  at  other  times  from  that  of  another ;  and  that  the" 
same  influences — sudden  transitions  of  temperature,  and  the  like — 
act  in  some  instances  as  an  efficient  cause,  and  in  others  lower 
themselves  to  the  secondary  office  of  exciting  into  action  an  inflam 
mation  produced  by  another  agency. 

Autumnal  fevers,  if  not  produced  like  other  zymotic  diseases,  are  localized 
in  certain  places;  not  so  pneumonia. — Let  us  examine  the  subject  in  an 
other  point  of  view,  and  acknowledge,  for  a  moment,  that  remittent, 
intermittent,  and  yellow  fevers,  and  other  zymotic  diseases  more  or 
less  allied  to  them,  are  not  the  offspring  of  peculiar  morbid  poisons 
exhaled  from  the  localities  where  they  prevail;  and  are,  so  far  as  that 
goes,  on  a  par  with  pneumonic  inflammations ;  I  am  not  sure  that  the 
admission  would  afford  much  help  to  those  whose  opinions  are  under 
examination ;  for  it  is  impossible  to  shut  our  eyes  to  the  fact,  that 


AUTUMNAL   FEVERS.  355 

the  localization  of  those  diseases  takes  place  only  where  certain 
peculiar  combinations  of  materials  appertaining  to  the  soil,  or 
which  have  found  their  way  there  accidentally  or  otherwise,  exist. 
Bearing  this  in  mind,  we  arrive  at  once  at  the  conclusion,  that 
the  real  cause,  whatsoever  it  may  be,  meets  there  certain  agencies 
which  so  modify  the  system  as  to  render  it  liable  to  their  morbid 
impress.  In  a  word,  what  many  regard  as  the  active  and  effi 
cient  cause  of  those  diseases,  may,  after  all,  be  only  a  predisposing 
agent.  If  this  be  correct,  autumnal  and  periodic  fevers  are,  in  that 
respect,  on  an  equal  footing  with  other  zymotic  diseases  arising 
from  specific  ferments  or  poisons.  Every  one  knows  that  while 
Asiatic  cholera  and  the  febrile  exanthemata  are  never  produced  by 
the  malarial  exhalations  evolved  from  foul  localities  or  marshy 
surfaces ;  while  typhus  and  typhoid  fevers  are,  as  it  is  said,  seldom 
the  offspring  of  the  former,  and  certainly  never  of  the  latter ;  while 
none  of  these  diseases  are  occasioned  by  the  ingestion  of  putrescent 
food,  by  the  use  of  foul  water,  by  imperfect  ventilation,  by  starva 
tion,  by  excessive  muscular  exertions,  by  the  intemperate  use  of 
alcoholic  liquors,  and  the  like ;  and  while,  with  the  exception,  per 
haps,  of  typhus,  they  do  not  arise  from  the  effluvia  proceeding  from 
the  human  body — particularly  the  lungs  and  skin — and  consisting 
of  the  effete  and  highly  putrescent  matter  mingled  with  the  air  or 
perspiration — it  is  a  notorious  fact,  that  they  are  principally  rife  in 
situations  where  such  influences  operate,  and  strike  with  greater 
violence,  malignancy,  and  fatality  among  individuals  exposed  to 
their  baneful  effects.  This  is  true,  whether  the  disease  be  the  pro 
duct  of  a  zymotic  poison  floating  in  the  atmosphere,  and  independ 
ent  for  its  development  of  any  organic  process,  as  Asiatic  cholera; 
or  whether  it  arises  from  a  poison  formed  in  the  system  and  trans 
missible  from  one  individual  to  another  through  means  of  contact, 
or  the  medium  of  the  atmosphere ;  or  whether,  again,  it  is  due  to 
a  particular  poison  proceeding  from  external  sources  of  animal  or 
vegetable  decomposition,  or  from  the  result  of  a  morbific  condition 
of  the  sj^stem,  as  is  the  case,  perhaps,  with  puerperal  complaints, 
erysipelas,  and  surgical  fever. 

It  will  only  be  necessary  to  open  the  records  of  cholera  in  all  the 
countries  it  has  visited,  and  especially  in  England,  where  the  sub 
ject  has  been  investigated  with  greater  attention  than  elsewhere,  or 
of  typhus  or  typhoid  fevers,  to  be  perfectly  satisfied  that,  where  the 
predisposing  influences  in  question  exist,  there  these  diseases  rage 


356  PNEUMONIA    AND 

with,  the  greatest  violence.  Indeed,  as  Dr.  Grainger  well  remarks, 
before  the  outbreak  of  any  epidemic,  knowing  where  the  predis 
posing  causes  are  rife,  physicians  can  foretell  the  precise  localities 
where  it  will  occur ;  nay,  even  name  the  alley,  or  point  to  the  exact 
house  that  will  suffer.1 

Now  admitting,  as  already  remarked,  that  autumnal  fevers,  of  all 
possible  grades,  are  to  be  placed  in  the  same  category  with  the 
diseases  mentioned;  admitting  that  the  same  relationship  exists 
between  them  and  the  morbid  influences  above  specified,  as  between 
these  and  the  other  forms  of  zymotic  complaints ;  in  other  words, 
admitting,  that  not  only  intemperance,  starvation,  imperfect  ventila 
tion,  putrescent  food,  foul  water,  but  marsh  miasmata  and  malaria 
generally,  are  restricted  in  their  agency  to  the  predisposing  of  the 
system  to  receive  the  morbid  impressions  of  the  efficient  cause,  it 
would  not,  be  the  less  true,  that  there  exists  a  wide  difference  in 
that  respect  between  those  fevers  and  pneumonia. 

We  have  already  seen  that  the  latter  disease,  so  far  from  being 
necessarily  more  frequent  in  malarious  countries,  has  often,  if  not 
generally,  been  noticed  to  prevail  less  extensively  there  than  in 
places  differently  circumstanced.  Malaria,  therefore,  cannot  be  re 
garded  as  its  predisposing  cause.  If  we  turn  to  our  wharves,  courts, 
alleys,  and  the  habitations  of  the  poor,  where  sources  of  foul  exha 
lations,  of  every  kind  imaginable,  are  abundant,  we  do  not  find  that 
pneumonia  is  more  generally  noted  there  than  in  other  localities. 
Nor  do  we  find  that  putrescent  food,  foul  water,  imperfect  ventila 
tion,  starvation,  intemperance,  or  concentrated  human  effluvia,  exer 
cise  an  important  influence  in  localizing  the  disease  and  increasing 
its  prevalence.  These  morbid  agencies,  and  a  few  others  which 
predispose  to  fevers,  may  have  an  injurious  effect  as  regards  pneu 
monia;  they  may,  by  lowering  the  tone  of  the  system,  and  diminish 
ing  the  power  of  the  latter  to  resist  the  force  of  the  morbid  impres 
sion,  increase,  to  a  certain  extent,  the  danger  of  the  attack ;  in  the 
same  way  as  do  advanced  age  and  other  causes  of  constitutional 
prostration.  But  the  injurious  effect,  so  far  as  regards  predisposi 
tion,  is  comparatively  restricted  in  reference  to  pneumonia;  while  in 
regard  to  fevers  and  other  zymotic  diseases,  it  is  strikingly  great. 
Pneumonia  attacks,  and,  the  force  of  the  constitution  being  the 

1  Influence  of  Noxious  Effluvia  on  the  Origin  and  Propagation  of  Epidemic  Diseases. 
Quoted  by  Med.  Exam.  April,  1853,  p.  253. 


AUTUMNAL    FEVERS.  357 

same,  is  equally  fatal  among  all  classes  of  society,  the  rich  and  the 
poor.  We  possess  no  authentic  statements  calculated  to  show  that 
the  latter  are  more  prone  to  the  disease  than  the  former ;  for,  if 
among  the  rich  thoracic  inflammations  have  occasionally  been 
found  to  prevail  less  extensively,  the  explanation  may  be  readily 
found  in  the  fact  that  they  are  less  exposed,  not  to  the  modi 
fying  influences  above  mentioned,  which,  as  we  have  seen,  predis 
pose  to  fevers  and  zymotic  complaints  generally,  but  to  the  injuri 
ous  impression  of  the  ordinary  exciting  causes  of  the  disease.  In  a 
word,  autumnal  and  periodic  fevers  of  all  grades — supposing  them 
not  to  be  produced  by  malarial  exhalations — are  like  other  zymotic 
diseases,  principally  rife  among  individuals  whose  systems  have 
been  for  a  greater  or  less  period  of  time  under  the  depressing 
influence  of  such  exhalations.  These,  like  the  rest  of  the  recog 
nized  morbific  influences  mentioned,  must,  at  the  very  least,  be 
admitted,  in  accordance  with  that  view  of  the  matter,  to  act  inju 
riously  by  predisposing  the  system  to  the  action  of  the  disease;  and 
when  examined  attentively,  the  effect  will  be  found  to  be  evidently 
accomplished,  as  Dr.  Carpenter  well  remarks,  by  producing  in  the 
blood  of  the  individual  exposed  to  them  an  excess  of  those  decom 
posing  organic  compounds,  which,  as  physiology  teaches  us,  are 
always  present  in  the  circulating  current,  in  minute  proportion ; 
being  conveyed  by  it  from  the  spots  in  which  they  are  introduced, 
or  in  which  they  are  generated,  to  the  organs  through  which  they 
are  to  be  eliminated ;  and  an  excess  of  which  is  manifestly  produ 
cible,  either  by  the  direct  introduction  of  those  matters  from  with 
out,  in  the  food  or  drink  consumed,  or  in  the  air  respired  ;  or  by 
the  production  of  them  within  the  body,  at  a  rate  beyond  that  at 
which  they  are  normally  eliminated ;  or  by  some  obstacle  to  their 
elimination,  which  prevents  the  amount  ordinarily  originated  from 
escaping  at  its  normal  rate  through  the  usual  outlets.1  It  would 
puzzle  the  most  clairvoyant  among  the  advocates  of  the  hypothesis 
under  examination,  to  discover  and  point  out  the  existence  of  the 
most  distant  analogy  in  regard  to  the  subject  just  mentioned,  be 
tween  pneumonia  and  autumnal  fevers;  for  while  the  predisposing 
if  not  efficient  causes  of  the  latter  are  of  the  nature  stated,  and 
exercise  their  baneful  influence  in  the  way  mentioned;  while  for 
this  reason  those  fevers  establish  their  claims  to  take  rank  among 

1  Brit,  and  For.  Med.-Chir.  Rev.  Jan.  1853,  p.  102. 


358  PNEUMONIA    AND 

zymotic  diseases ;  pneumonia  recognizes  for  its  predisposing  causes 
agencies  of  a  very  different  character ;  such  as,  instead  of  lowering 
the  purity  of  the  blood,  tend  to  increase  its  vitality,  and  would,  in 
the  absence  of  a  thousand  other  reasons,  suffice  to  put  a  bar  to  the 
idea  of  placing  the  disease  among  the  zymotics,  and  establishing  a 
parallel  between  it  and  fevers. 

The  opinion  is  incorrect,  for  it  leads  to  the  inference  that  the  same 
cause  produces  diseases  differing  widely  in  symptoms  and  anatomical 
characters. — Nor  does  it  appear  less  certain  that  the  theory,  or  more 
properly  the  hypothesis,  under  examination,  is  faulty  in  another 
point  of  view ;  for  while,  as  has  been  seen,  it  admits  that  the  pneu 
monia  of  the  south,  if  not  pneumonia  generally,  is  in  some  instances 
an  idiopathic  affection,  and  hence  arises  from  causes  distinct  from 
those  to  which,  it  is  thought,  the  disease  should,  in  the  majority  of 
cases,  be  referred ;  in  other  words,  while  in  accordance  with  that 
belief,  inflammation  of  the  lungs  may  be  the  offspring  of  two  dif 
ferent  sets  of  causes,  we  are  given  to  understand  that  from  the  same 
cause — malaria,  according  to  some,  and  atmospheric  influences, 
agreeably  to  others — there  may  and  do  arise  various  series  of  mor 
bid  phenomena,  which,  when  examined,  are  found  to  bear  no 
resemblance  to  each  other,  and  which,  consequently,  medical  ob 
servers,  from  the  days  of  Galen,  if  not  of  Hippocrates,  to  our  own, 
have,  with  scarcely  an  exception,  regarded  as  essentially  dissimilar. 
"What  diseases,  indeed,  in  the  long  list  of  those  flesh  is  heir  to,  differ 
more  widely  from  each  other  than  pneumonia  and  malarial  fever  ? 
Of  the  former,  the  seat  is  necessarily  the  substance  of  the  lungs, 
with  or  without  an  implication  of  their  covering  and  lining  mem 
brane,  in  which  morbid  changes  are  effected  that  need  not  to  be 
specified  here.  AVhile  this  is  the  case  with  these  organs  and  tis 
sues,  the  contents  of  the  abdominal  and  other  cavities  may,  and  do 
often  remain  unaffected  to  the  last ;  or  if  they  become  implicated  at 
the  outset,  or  during  the  course  of  the  attack,  the  effect  is  generally 
due  to  causes  independent  of  that  which  gave  rise  to  the  thoracic 
affection.  When,  in  such  cases,  the  inflammation  of  the  lungs  has 
been  removed  by  proper  means,  or  when,  as  not  unfrequently  hap 
pens — witness  the  effects  of  homoeopathy — it  subsides  through  the 
influence  of  the  recuperative  powers  of  the  system,  the  fever  by 
which  it  was  accompanied  disappears  also,  unless  some  other  organ 
or  tissue  has  taken  on  inflammation,  and  the  latter  keeps  up  febrile 


AUTUMNAL    FEVERS.  359 

excitement ;  or  unless  the  case  be  complicated  from  the  onset  with 
some  other  complaint.  This  result  could  scarcely  be  looked  for 
were  the  disease  a  constitutional  one,  caused  by  some  general  agency, 
and  the  local  affection  only  a  secondary  effect  superadded  to  the  pri 
mary  complaint.  So  far  from  this,  the  fever  in  pneumonia  is  depend 
ent  on  and  inseparable  from  the  pulmonary  inflammation,  the  removal 
of  which  is  necessarily  followed  by  the  cessation  of  the  former. 

On  the  other  hand,  the  febrile  poison  manifests  an  affinity  for  the 
abdominal  viscera,  which  are  affected  to  a  greater  or  less  extent  in 
the  large  majority  of  cases.  While  doing  this,  it  sometimes  spreads 
its  effects  to  the  brain  or  its  membranes ;  which,  however,  are  more 
frequently  involved  in  a  secondary  than  in  a  primary  way.  But 
whatsoever  be  the  morbid  impression  produced  on  these  organs,  the 
poison  does  not  injure  the  pulmonary  tissues,  for  which  it  has  no 
affinity — so  far  at  least  as  to  excite  in  them  the  inflammatory  change. 
Even  on  the  abdominal  organs,  it  does  not  always  excite  true 
inflammation;  or  when  it  does,  the  effect  is  felt  by  the  mucous  sur 
faces  and  secretory  organs,  and  not  by  the  serous  and  parenchyma- 
tous  structures.  If  these  at  any  time,  and  in  any  case,  become  the 
seat  of  inflammation,  the  result  is  due  to  fortuitous  circumstances, 
and  does  not  constitute  an  essential  part  of  the  disease,  which  may 
and  does  generally  exist  and  run  its  course,  to  recovery  or  death, 
clothed  in  all  its  legitimate  and  characteristic  colours,  without  ex 
hibiting  evidence  of  such  an  implication.  Contrary  to  what  occurs 
in  pneumonia,  when,  in  pure  and  uncomplicated  cases  of  autumnal 
or  periodic  fevers,  the  physician  succeeds  in  removing  all  the  local 
inflammations  which  may  exist,  he  must  not  be  too  sanguine  about 
putting  a  stop  to  the  fever  itself;  for  the  chances  are  a  hundred  to 
one  that  it  will  continue  to  run  its  course,  uninfluenced  in  that 
respect  by  the  cure  of  the  local  disease ;  in  the  same  way  that  the 
alligator's  head,  in  the  experiments  of  a  distinguished  physiologist 
of  our  country,  continued  to  live — saw,  winked,  snapped,  and  even 
jumped — though  deprived  of  its  usual  appendage,  the  body. 

Affinity  of  morbific  and  therapeutic  agents  for  special  organs  not  to 
be  denied.  —The  fact  of  the  affinity  of  deleterious  agents  for  a  par 
ticular  part,  is  not  one  of  which  a  well-read  and  observant  physician 
can  be  ignorant;  it  has  been  observed  and  admitted  from  time 
immemorial.  More  than  a  century  ago,  Borden,  whose  authority  in 
matters  of  the  sort  will  not  be  impugned,  remarked  :  "  All  morbific 


360  PNEUMONIA    AND 

miasms  have  their  organs  marked  and  predisposed  for  their  germina 
tion.  It  is  in  these  organs  that  each  miasm  penetrates ;  it  is  for  them 
it  has  a  special  tendency;  the  herpetic  attacks  the  skin,  the  scrofulous 
the  glands,  the  venereal  the  organs  of  generation.  The  poison  of 
gout  affects  the  whole  nervous  system,  and  is  only  developed  in  the 
articular  membranes.  Each  imparts  to  the  individual  in  whom  it 
germinates  peculiar  modifications,  often  of  a  diseased  kind,  often  also 
consisting  of  a  particular  manner  of  being,  or  a  well-characterized 
temperament."1  At  a  later  period,  Mr.  Hunter  stated,  in  language  no 
less  explicit,  that  "  poisons  take  their  different  seats  in  the  body  as 
if  they  were  allotted  to  them."  In  a  word,  such  agents,  when  intro 
duced  into  or  applied  to  the  system,  do  not  produce  their  effects 
on  all  the  organs  or  tissues  indiscriminately.  So  far  from  this, 
each  morbid  or  common  poison,  each  article  producing  some  phe 
nomenon  which  links  it,  as  to  its  effects,  with  other  articles,  gives 
rise  to  phenomena  of  a  special  character,  and  is  often  found  to 
occasion  lesions  of  specific  organs.  While  putrid  substances, 
when  inhaled  into  the  lungs,  or  thrown  into  the  circulation,  affect 
the  gastro-intestinal  surface,  the  subcarbonate  of  soda  applied  in 
the  latter  way  disorganizes  the  thoracic  viscera.  The  lungs  be 
come  gorged  with  blood,  which  gushes  out  when  incisions  are  made 
into  their  substance,  and  bloody  fluid  is  effused  into  the  pleura, 
while  the  tissues  and  organs  of  the  abdominal  cavity  are  found  in 
their  normal  state.2  The  lungs  are  specially  affected  by  the  bichlo- 
rate  of  mercury;  the  bronchia  attract  and  eliminate  phosphorus; 
the  heart  is  affected  by  the  upas  antiar  and  digitalis ;  the  kidneys  by 
cantharides,  oil  of  turpentine,  indigo,  saffron,  and  nitrate  of  potash ; 
the  liver  by  verdigris;  the  same  or  some  other  secretory  organs  are 
affected  b}r  mercury ;  the  stomach  by  ipecacuanha,  colchicum,  and  tar 
tar  emetic;  the  bowels  and  not  the  stomach  by  purgatives;  the  brain 
by  opium ;  the  spinal  marrow  and  nervous  system  by  nux  vornica 
and  prussic  acid ;  the  uterus  by  ergot ;  the  capillary  system  by  eu- 
phorbium,  &c.3 

The  advocates  of  the  malarial  origin  of  pneumonia,  some  of  whom 
seem  to  have  forgotten  this  power  of  affinity,  would  do  well  to  bear 
these  facts  in  mind:  as  also  the  pustules  of  smallpox;  the  cynanche 
and  erythema,  and  kidney  affections  of  scarlatina ;  the  intestinal 

1  Borden,  Analyse  Med.  du  Sang,  in  Collected  Works,  1011,  1012. 

2  Magendie  on  the  Blood,  178,  188,  101,  &c. 

3  See  Blake,  Sir  Everard  Home,  Haller,  Magendie,  Lcgallois,  Gaspard,  Simon,  &c. 


AUTUMXAL    FEVERS.  361 

ulcers  of  typhoid  fever;  the  catarrh  and  eruption  of  measles;  the 
rupia  and  periostitis  of  syphilis  ;  the  swollen  parotid  of  mumps ;  the 
suppurating  tumours  of  glanders ;  and  other  similar  local  affections 
which  present  themselves  daily  to  our  observation.  Let  them  do 
so ;  and  remember,  at  the  same  time,  that  "  syphilis  never  produces 
ulcers  in  the  ileum,  scarlatina  never  causes  iritis,"  and  that  "the 
causative  poison  of  the  one  disease  differs  from  the  causative  poison 
of  the  other,  for  on  the  selfsame  subject  it  produces  different 
effects,"1  and  they  will,  perhaps,  feel  less  reluctance  in  admitting 
that  the  malarial  poison  exercises  its  specific  effects  on  the  mucous 
tissue  of  the  gastro-intestinal  apparatus,  and  on  the  spleen,  and 
leaves  the  pulmonary  organs  uninjured.2 

Distinctive  symptoms  and  pathological  conditions  different  in  pneu 
monia  and  malarial  fevers. — In  all  that  precedes,  I  am  borne  out  by 
the  symptoms  observed  during  life  in  the  two  diseases.  In  the 
former  (pneumonia),  the  phenomena  indicate  the  existence  of  acute 
inflammation,  and  greater  or  less  congestion  of  the  organ  affected ; 
while  the  blood  exhibits  changes,  as  well  in  regard  to  the  propor 
tion  of  its  fibrin  and  other  elements,  as  to  its  physical  characters, 
which  not  only  prove  it  to  differ  considerably  from  the  healthy 
fluid,  but  assimilate  the  disease  to  a  class  very  unlike  the  pyrexise. 
It  need  scarcely  be  remarked,  that  in  all  inflammations  the  blood  is 
in  what  has  been  denominated  a  state  of  hyperinosis.  It  contains 
more  fibrin  than  in  the  normal  state — 5  or  6  parts  in  1,000,  instead 
of  2  or  3 — while  the  corpuscles  decrease  in  proportion  to  the  excess 
of  the  fibrin,  from  about  141.1  in  1,000  to  about  128.0.  The  fatty 
matter  also  is  increased ;  and,  as  a  consequence  of  all  these  changes, 
the  whole  solid  residue  is  diminished.  The  blood  coagulates  more 
slowly  than  in  the  normal  state ;  the  clot  is  not  usually  small,  but 
very  firm  and  consistent,  and  does  not  break  up  for  a  considerable 

1  Simon's  Lectures  on  Gen.  Path.  191. 

2  "If  we  were  to  attempt  to  explain  how  it  happens  that  particular  organs  are 
affected  rather  than  others,  we  must  do  so  upon  the  most  crude  hypothesis.     We  must, 
therefore,  as  well  observed  by  Mr.  1'iorry,   accept  the  facts,  without  being  able  to 
account  for  them.     Chemists  cannot  tell  you  why  carbon  has  more  affinity  for  oxygen 
than  for  azote ;  nor  can  physicians  tell  why  cantharides,  taken  into  the  blood,  act 
rather  upon  the  kidneys  than  upon  the  brain.     Whether  we  regard  medicines  or 
poisons,   morbid  secretions,  excretions,   contagions,  or  miasmata,  absorbed  into  the 
blood,  these  observations  are    equally  applicable," — AncclVs  Lectures  on  the 
Lancet,  1840,  p.  781, 


362  PNEUMONIA    AND 

time.  It  is  almost  invariably  covered  with  a  buffy  coat,  which,  is 
firm,  tough,  and  intimately  connected  with  the  clot ;  its  edge  is  often 
turned  upwards  and  its  surface  uneven.  If  the  clot  be  small,  the 
buffy  coat  and  the  surface  of  the  clot  arc  more  or  less  cupped,  and 
the  serum  is  of  a  pure  lemon  colour,  not  tinged  red.  When  whip 
ped,  the  fibrin  separates  in  thicker  and  more  solid  masses  than  in 
ordinary  blood.  After  the  removal  of  the  fibrin  the  corpuscles 
quickly  sink,  and  frequently  occupy  only  one-fourth  of  the  whole 
fluid,  while  in  healthy  blood  they  sink  very  imperfectly,  or  not  at  all. 
The  blood  has  always  an  alkaline  reaction,  and  is  of  a  higher  tem 
perature  than  in  the  ordinary  state.  All  these  changes  are  propor 
tionate  to  the  degree  of  the  inflammation.1  Such  is  the  condition 
of  the  blood  in  the  phlegmasiaB  generally.  In  pneumonia,  the  state 
of  hyper inosis  is  even  more  decided  than  in  other  diseases  of  that 
class,  as  the  blood  retains  its  heat  longer ;  the  clot  is  below  the 
ordinary  size,  and  very  consistent,  and  does  not  break  down  for  a 
considerable  time.  It  admits  of  being  sliced,  and  the  sections  retain 
their  consistency  for  some  time.  Its  surface  is  covered  with  the 
buffy  coat,  and  is  more  or  less  cupped.  The  serum  is  of  a  pure 
yellow  colour.  The  quantity  of  solid  constituents  is  usually  less 
than  in  healthy  blood.  The  proportion  of  fibrin  increases  and 
varies,  according  to  Andral  and  Gavarret,  from  4  to  10.5  in  1,000 
parts,  with  a  mean  (in  58  experiments)  of  7.5  ;  from  5.919  to  12.726, 
according  to  Kinclskopf,  and  3.4  to  9.15,  with  a  mean  of  6,  accord 
ing  to  Simon ;  while  the  blood-corpuscles,  according  to  the  first 
experimenters,  amount  to  from  83.2  to  137,  with  a  mean  of  114.1 ; 
and,  according  to  Simon,  to  as  little  as  from  36  to  78.2  If  other 
symptoms  present  themselves,  or  if  the  blood  assumes  a  different- 
appearance,  these  results  are  due  to  complications;  they  do  not 
constitute  a  necessary  link  in  the  chain  of  phenomena  imparting  an 
individuality  to  the  disease,  and  are  not,  therefore,  pathognomic. 

Examine  we  now  the  distinctive  symptoms  of  periodic  and 
autumnal  fevers — (applying  to  those  terms  their  most  enlarged 
sense) — those  symptoms  which  alone  enable  us  to  diagnose  those 
fevers — which  impart  to  them  their  individuality,  and  assign  them 
an  independent  position  in  every  nosological  arrangement,  and  we 
shall  not  discover  one  calculated  to  lead  us,  for  a  moment,  to  the 

!  Geo.  Polli,  Richerche  ct  Esperienze,  sul  san<rue  umano  Annali  Universal],  cxiii. 
333;  Simon,  Animal  Chem.  i.  l>r»0;   T.  W.  Jones,  Ediub.  Journ.  Ixxvi.  108. 
2  Simon,  op.  cit.  I  258,  259,  i!i;2. 


AUTUMXAL    FEVERS.  363 

supposition  tliat  the  lungs  are  the  seat  of  inflammation  or  acute 
congestion.  So  far  from  it,  indeed,  respiration  is  less  impaired  in 
the  early  stage  of  those  diseases  than  most  of  the  other  great 
functions.  When  it  becomes  deranged,  the  effect  is  of  a  nervous 
character,  or  the  result  of  the  inability  of  the  blood-corpuscles  to 
carry  oxygen ;  and  physical  exploration  usually  indicates  no 
important  morbid  change  in  the  pulmonary  tissue,  and  when  it 
does — as  more  frequently  occurs  during  the  latter  stage  of  malig 
nant  cases — the  signs  are  those  of  passive  congestion.  Bronchitis, 
except  in  a  very  few  cases,  is  not  developed,  and  when  so,  is  usually 
traced  to  its  legitimate  causes,  and  need  not  be  laid  to  the  score  of 
the  malarial  poison.  At  the  same  time,  all  the  symptoms  observed 
— all,  I  repeat,  that  are  pathognomonic — point  most  usually  to  the 
stomach,  bowels,  liver,  and  spleen,  sometimes  to  the  brain,  as  being 
the  organs  principally  implicated.  Sometimes  they  indicate  the  exist 
ence  of  acute  inflammation  in  one  or  more  of  these — more  gene 
rally  of  simple  congestion,  and  more  frequently  still  of  functional 
disorder  of  the  former,  with  or  without  congestion  of  the  latter — 
of  the  spleen  particularly — which  in  some  of  the  pyrexice  bears  a 
large  share  of  the  brunt  of  the  disease.  The  blood  at  the  same 
time  either  exhibits,  as  in  some  of  the  milder  forms  of  the  disease 
— simple  intermittents,  for  example — or  in  the  early  stages  of  other 
forms  of  a  more  severe  character,  little  or  no  change  from  its  nor 
mal  state ;  or  manifests  in  the  more  advanced  stage  of  these,  and 
even  in  some  cases  of  intermittents,  as  well  as  in  the  early  stages  of 
the  other,  and  particularly  in  the  malignant  grades,  alterations  in 
its  chemical  composition  and  plrysical  characters  the  very  reverse 
of  those  observed  in  pneumonia  and  the  phlegmasiaB  generally. 
The  fluid  is  in  that  state  which  has  received  the  denomination  of 
hypinosis.  The  fibrin  is  frequently  less  than  in  healthy  blood,  or 
if  it  amounts  to  the  normal  quantity,  its  proportion  to  the  blood- 
corpuscles  is  less  than  is  found  in  a  state  of  health  (2.1  :  110,  Simon, 
or  3  : 110,  Lecanu) ;  the  quantity  of  corpuscles  is  either  absolutely 
increased,  or  their  proportion  to  the  fibrin  is  larger  than  in  the 
healthy  state ;  and,  in  addition,  the  quantity  of  solid  constituents  is 
also  frequently  larger  than  in  the  normal  fluid. 

The  clot,  though  sometimes  small,  is  more  commonly  the  reverse. 
It  is  soft,  diffluent,  and  of  a  dark,  almost  red  colour.  Occasionally, 
indeed,  no  clot  is  formed.  The  buffy  coat  is  seldom  seen,  and  when. 
this  is  the  case,  is  thin  and  soft,  and  forms  a  gelatinous  parti-coloured 


364  PNEUMONIA    AND 

deposit  on  the  clot.  The  serum  is  sometimes  of  a  deep  yellow 
tinge  from  the  colouring  matter  of  the  bile ;  or  red,  from  blood- 
red  corpuscles  in  suspension.  The  blood  has  always  an  alkaline 
reaction.1  In  some  forms  of  the  disease,  it  even  approaches  that 
state  denominated  spanoemia ;  it  is  watery,  very  poor  in  fibrin,  and 
of  a  dark  colour.  If  any  clot  be  formed,  it  is  diffluent  and  very 
soft,  the  serum  is  frequently  of  a  dark  yellow  or  brown-red  colour ; 
partly  from  the  colouring  matter  of  the  bile,  and  partly  from  dis 
solved  haematoglobulm.  It  possesses  a  very  peculiar  smell,  which 
not  improbably  depends  on  a  volatile  salt  of  ammonia.2  These 
changes,  which  can  be  artificially  produced  by  the  introduction  of 
putrid  substances  into  the  circulation,  are  observed  in  a  more  or 
less  marked  manner,  not  only  in  malarial  remittents,  sometimes  in 
intermittents,  but  also  in  typhoid,  typhus,  relapsing,  yellow,  and 
pestilential  fevers,  as  well  as  in  a  variety  of  other  diseases  arising 
from  the  action  of  morbid  poisons. 

The  fevers  of  this  country,  from  the  simple  intermittent  to  the 
malignant  yellow,  have  exhibited  them  to  a  greater  or  less  extent. 
As  regards  the  latter  form  of  the  disease,  the  altered  condition  of 
the  blood  has  been  noticed  by  Lining  and  Moultrie,  and,  since 
them,  by  Hush,  Deveze,  Nassy,  Physick,  Cathrall,  Brown,  Currie, 
Caldwell,  Miller,  Drysdale,  E.  II.  Smith,  Potter,  Gros,  Cartwright, 
Kelly,  Nott,  S.  Jackson,  Stone,  and  by  almost  every  other  writer 
on  the  subject.  It  is,  indeed,  a  fact  of  so  notorious  a  character,  as 
not  to  call  for  any  special  illustration  in  this  place.  Kot  less  evi 
dent,  though  perhaps  not  so  distinctly  marked,  are  the  changes  in 
question  on  the  milder  forms  of  the  disease.  They  were  noticed  by 
Dr.  John  Mitchell,  in  the  fever  he  observed  in  Virginia  in  1737, 
1741,  42,  and  which  was  improperly  denominated  yellow  fever.3 
Since  then,  attention  has  been  called  to  them  in  a  more  or  less 
pointed  manner  by  Drs.  Daniels,  Dickson,  Drake,  Stewardson,  and 
other  American  writers,  as  also  by  Dr.  Stevens,  who  had  an  oppor- 

1  Simon,  Animal  Chemistry,  i.  287,  301,  302. 

2  Ibid.  i.  319  ;   ibid.  Appendix,  ii.  510. 

Salvagnoli  examined  the  blood  of  four  persons  actually  labouring  under,  or  who 
had  just  recovered  from  intermittent  fever,  and  were  living  in  a  malarious  district. 
He  found  that  it  exhibited  a  notable  diminution  of  albumen  and  fatty  matter,  and  that 
the  phosphates  had  almost  entirely  disappeared.  It  contained,  however,  a  large 
quantity  of  cholesterin.  It  is  remarked  that  the  biliary  secretion  of  those  living  in 
such  districts  has  been  previously  noticed  to  be  rich  in  cholcsteriu.  Saggio  illustra 
tive  dclla  Statistica  Medico,  dclla  Maremme  Toscane,  00. 

3  Med.  and  Philos.  Register,  iv.  188. 


AUTUMNAL    FEVEES.  365 

tunity,  during  his  visit  to  this  country,  to  observe  our  lake  and 
marsh  fevers.  It  would  be  useless  to  enter  at  large  on  the  sub 
ject  ;  and  I  shall  content  myself  with  making  room  only  for  a  brief 
summary  of  observations  made  on  the  subject  by  Dr.  Frick  of  Balti 
more.  This  writer  examined  twelve  cases  of  autumnal  fever.  Of 
these,  five  were  of  the  remittent,  and  the  balance  of  the  intermittent 
type.  In  two  of  those  cases — one  of  the  intermittents,  and  one  of  the 
remittents,  the  disease  assumed  the  congestive  form.  In  four  classed 
as  remittents,  the  proportion  of  the  fibrin  was  above  the  usual 
standard.  In  the  fifth  case  of  that  class,  the  disease  was  of  three 
weeks'  duration,  and  all  the  elements  of  the  blood,  except  the  chlo 
rides  and  the  phosphates,  were  below  their  natural  standard.  In 
five  of  the  cases  of  intermittent  fever  out  of  seven,  the  fibrin  was 
below  the  average  quantity.  Of  the  two  exceptional  cases,  one  was 
complicated  with  ascites,  and  oedema  of  the  lower  extremities,  coming 
on  as  an  acute  affection,  and  being  preceded  by  a  chill;  and  the 
other  was  complicated  with  pneumonia  at  the  summit  of  the  lung. 
The  increase  of  fibrine  in  the  four  cases  of  remittents,  as  above 
mentioned,  was  due  to  the  superaddition  of  gastro-duodenitis  to  the 
original  disease.  The  blood-globules  in  the  remittent  form  were, 
as  is  the  case  in  the  pyrexia  generally,  in  all  the  instances  except 
the  one  above  alluded  to,  increased.1 

The  same  changes  have  been  noticed  not  only  as  regards  typhus, 
typhoid,  and  relapsing  fevers,  but  common  malarial  diseases,  in 
England,  France,  Ireland,  Scotland,  Italy,  and  Germany,  as  well  as 
in  the  West  Indies,  Algeria,  Western  Africa,  &c.,  as  the  reader  may 
readily  find  by  referring  to  the  writings  of  Huxham,  Cleghorn, 
Sarcone,  E.  Armstrong,  Evans,  Tweedie,  Cormack,  Stevens,  Boyle, 
J.  Davy,  Andral  and  Gavarret,  Leonard  and  Foley,  Clanny,  Burne, 
Stokes,  Keid,  Stoker,  Haspel,  Boudin,  Me  Williams,  Jennings,  J. 
Armstrong,  Lecanu,  Cozzi,  Salvagnoli,  F.  Home,  and  Clot-Bey,  to 
say  nothing  of  the  very  large  majority  of  authors  who  have  treated 
of  the  yellow  fever  of  Spain  and  tropical  regions. 

In  the  same  way  that  in  pneumonia  we  find  that  a  condition  of 
blood,  more  or  less  approximating  to  the  one  mentioned  above, 
indicates  the  complication  of  a  typhoid  diathesis,  or  of  a  strong  mala 
rial  taint,  so  in  fevers  arising  from  the  latter  cause,  or  in  the  pyrexise 

1  Of  the  Relative  Proportions  of  the  different  Organic  and  Inorganic  Elements  of 
the  Blood  in  different  Diseases,  Am.  J.  xv.  (N.  S.)  29. 


366  PNEUMONIA    AND 

generally,  the  excess  of  fibrin,  and  its  greater  proportion  relatively 
to  the  blood-corpuscles,  indicates  the  existence  of  a  phlegmasia  in 
addition  to,  but  forming  no  essential  part  of,  the  disease. 

These  changes  in  the  appearance  of  the  blood  are  noticed  not 
only  during  the  attack  of  malarial  fever;  they  have  been  observed 
even  in  individuals  in  apparent  health  residing  in  malarial  regions, 
and  especially  during  the  prevalence  of  an  epidemic  of  remittent, 
intermittent,  or  yellow  fever;  and,  indeed,  of  many  other  forms 
of 'zymotic  diseases.  The  late  Dr.  John  Mitchell,  of  Virginia,  in 
the  account  he  left  us  of  the  so-called  yellow  fever  which  prevailed 
in  some  parts  of  that  State  about  the  middle  of  the  last  century, 
remarks :  "  Even  those  who  are  bled  after  a  received  contagion 
before  the  fever  is  formed,  have  a  thin,  dissolved,  florid  blood,  even 
in  winter.  This  was  the  constant  state  of  the  blood  in  about  thirty 
or  forty  whom  I  have  known  to  have  been  bled  at  all  seasons  of 
the  year."1  Alluding  to  the  fever  of  Baltimore  in  1800,  Dr.  Potter 
says:  "To  ascertain  the  appearance  of  the  blood  in  subjects  appa 
rently  in  good  health,  I  drew  it  from  five  persons  who  had  lived, 
during  the  whole  season,  in  the  most  infected  parts  of  the  city,  who 
were,  in  every  external  appearance  and  inward  feeling,  in  perfect 
health.  The  appearance  of  the  blood  could  not  be  distinguished 
from  that  of  those  who  laboured  under  the  most  inveterate  grades 
of  the  disease.  A  young  gentleman  having  returned  from  the 
western  part  of  Pennsylvania,  on  the  10th  of  September,  in  good 
health,  I  drew  a  few  ounces  of  blood  from  a  vein  on  that  day;  it 
discovered  no  deviation  from  that  of  other  healthy  persons.  He 
remained  in  my  family  till  the  26th  of  the  month,  and,  on  that  day, 
I  repeated  the  bloodletting.  The  serum  had  assumed  a  deep  yellow 
hue,  and  a  copious  precipitate  of  red  globules  had  fallen  to  the  bot 
tom  of  the  receiving  vessel."2  Dr.  Archer,  of  Norfolk,  has  also 
noticed  the  same  fact,  stating,  as  an  evidence  of  the  extent  to  which 
the  predisposing  causes  of  this  fever  operated,  that  the  blood  taken 
from  healthy  persons  generally  exhibited  changes  which  were  easily 
discernible  as  it  trickled  down  the  sides  of  the  basin.  These  were 
pretty  regularly  increased  as  you  approached  the  infected  district.3 

The  same  fact  is  confirmed  in  regard  to  malarial  fevers  of  lower 
grades  by  the  results  of  observations  made  in  the  Tuscan  Maremma 

1  Mcd.  and  Philos.  lleg.  iv.  188.  2  A  Memoir  011  Contagion,  54. 

3  lli.<t.  oi'the  Ye!.  Fcv.  of  Norfolk  in  1821,  Mod.  lice.  v.  G8. 


AUTUMNAL    FEVERS.  367 

and  in  the  miasmatic  districts  of  this  country.  "  So  great  and  so  con 
stant  is  the  difference,"  says  a  high  authority  in  reference  to  the  for 
mer,  "that,  from  the  physical  examination  of  the  blood  only,  almost 
without  error,  the  physician  may  judge  if  the  patient  resides  con 
stantly  in  an  unhealthy  atmosphere,  and  if  the  liver  and  spleen  have 
been  altered."1  During  his  visit  to  the  United  States,  Dr.  Stevens  saw 
much  of  our  lake  fever,  especially  in  the  Genesee  country.  In  the 
months  of  September  and  October,  1830 — the  sickly  period — he  bled 
several  individuals  who  resided  in  some  of  the  infected  localities,  but 
had  not  yet  been  attacked  with  the  fever.  In  every  one  of  these,  the 
blood  invariably  presented  the  same  diseased  appearance  which  he 
had  often  observed  in  those  who  resided  near  to  swampy  situations 
in  the  West  Indies.  It  was  very  dark  in  colour,  and  evidently 
deranged  in  its  physical  appearance,  while  the  serum  which  sepa 
rated,  in  place  of  being  clear,  had  a  muddy  or  brown  colour,  and, 
in  some  cases,  an  oily  appearance.  In  fact,  Dr.  Stevens  did  not 
meet  with  even  one  intelligent  practitioner  in  that  country,  who 
was  not  aware  of  the  fact  that  the  blood  of  the  inhabitants,  during 
the  sickly  months,  is  very  different  from  that  of  those  individuals 
who  arrive  from  healthy  situations ;  whilst  even  in  those  who  re 
side  in  the  most  unhealthy  situations,  and  who  have  not  yet  had  the 
fever,  it  is  not  only  dark  in  colour,  but  evidently  so  much  diseased 
in  its  properties  as  to  be  very  unlike  the  blood  in  health.2 

To  this  it  may  be  added  that,  in  pneumonia,  the  blood  preserves 
its  ordinary  and  specific  odorous  exhalation;  while  in  diseases 
arising  from  the  action  of  the  malarial  poison — in  some  forms  of 
them  at  least — the  fluid  acquires  a  peculiar  odour  not  encountered 
in  other  complaints.  In  some  forms  of  fever — typhus,  plague,  and 
yellow  fever — the  blood  possesses  a  very  peculiar  smell,  which  pro 
bably  differs  in  each  disease,  and  is  produced  by  a  volatile  salt  of 
ammonia.3  Dr.  Stevens,  in  speaking  of  the  condition  of  the  blood 
in  what  he  calls  the  African  typhus,  remarks  that,  "when  first 
drawn,  it  has  a  peculiar  smell."4  And  Dr.  Eush,  in  his  account  of 
the  epidemic  of  1794,  mentions  that  a  similar  statement  was  made 
to  him  by  a  German  bleeder,  whose  experience  in  1793  was  very 
ample,  and  affirmed  he  could  distinguish  a  yellow  fever  from  all 
other  forms  of  fever.  "  From  the  certainty  of  his  decision  in  one 

1  Saggio  illustrative  le  Tavolc  della  Statistica  Medica.  della  Maremme  Toscane,  211. 

2  On  the  Blood,  216.  3  Simon,  op.  tit.  i.  319,  320. 
4  On  the  Blood,  210. 


368  PNEUMONIA    AND 

case  which  came  under  my  notice,"  adds  Dr.  Eush,  "  before  a  sus 
picion  had  taken  place  of  the  fever  being  in  the  city,  I  am  disposed 
to  believe  that  there  is  a 'foundation  for  his  remark."1  I  may  add, 
that  Mr.  Ripperger,  a  highly  respectable  bleeder  of  this  city,  who 
has  gone  through  all  our  epidemics  from  1793  to  the  present  day, 
and,  during  that  time — thanks  to  the  sj^stem  long  in  vogue — shed 
more  blood  than  any  ten  men  living  or  dead,  has  confirmed  to  me 
the  above  statement  of  Dr.  Rush's  authority.  And  why  should  it 
not  be  so?  It  is  known,  particularly  since  the  experiments  of 
Barruel,  that  the  blood  of  every  vertebrate  animal  has  in  it  an 
odoriferous  principle,  identical  in  all  the  individuals  of  the  same 
species,  and  similar  to  the  odour  of  the  cutaneous  transpiration,  or 
to  that  part  of  it  which  gives  to  each  animal  its  characteristic  smell. 
We  know,  also,  that  according  to  the  principle  laid  down  by  Bar 
ruel,  and  more  or  less  acknowledged  by  other  chemists,  that  the 
blood  of  each  individual  exhales  an  odour  closely  resembling  that 
of  the  cutaneous  perspiration,  and  so  peculiar  that  the  species,  and 
even  the  sex  of  any  animal  from  whom  a  given  quantity  of  blood 
has  been  drawn,  may  be  determined  by  it.2  It  is  known,  also,  that 
certain  poisonous  and  other  substances — ether,  hydrocyanic  acid, 
camphor,  and  alcohol,  which,  when  taken  into  the  system,  find  their 
way  into  the  circulation,  impart  peculiar  odours  to  the  blood;  and 
when  we  combine  these  various  circumstances  together,  we  cannot 
help  perceiving  that  the  malarial  poison,  when  absorbed,  may  so 
modify  that  fluid  as  to  produce  analogous  effects. 

Are  we  not  justified  in  explaining,  by  the  changes  which  occur 
in  the  blood  of  individuals  affected  with  autumnal  and  other  fevers, 
many  of  the  phenomena  which  present  themselves  in  the  course  of 
those  diseases?  On  the  subject  of  anemia  and  scorbutic  attacks, 
there  can  be  but  little  difficulty.  In  reference  to  intermittcnts,  a 
writer  in  the  Dublin  Journal  (vii.  219)  says,  and  his  remarks  apply 
equally  well  to  other  fevers :  "  The  diminution  of  the  globules 
(probably  also  a  diminution  of  their  power  of  absorbing  oxygen) 
explains  the  prostration  of  the  entire  constitution  and  the  occasional 
disturbances  of  the  circulation.  The  diminution  of  the  fibrin  ex 
plains  the  ecchymosis  on  the  skin  and  in  the  cellular  tissues,  the 
bleeding  from  the  nose  and  gums,  the  gangrene  of  the  mouth  which 
sometimes  occurs,  and  the  pain  in  the  limbs.  The  diminution  of 

1  Works,  iii.  '2'2',j.  2  Crit.  and  For.  Rev.  xi.  i!Jf). 


AUT-UMNAL    FEVERS.  369 

the  albumen  explains  the  hyclropsical  swellings,  anasarca,  ascites, 
and  probably  also  the  watery  diarrhoea,  which  always  closes  the 
last  scenes  of  persons  weakened  by  fever." 

Another  writer  remarks:  "The  first  action  of  the  poison  is  appa 
rently  upon  the  functions  of  the  blood;  those  are  impaired,  or,  in 
peracute  cases,  cease  altogether.  The  functions  of  the  blood  are, 
first,  to  maintain  the  activity  of  the  nervous  and  muscular  systems ; 
and,  secondly,  to  supply  the  materials  for  the  molecular  changes 
constantly  going  on  in  the  tissues.  It  is  essential  to  this  being 
properly  performed  that  the  blood-corpuscles  be  in  a  fit  condition 
to  carry  oxygen,  and  it  would  appear  from  the  symptoms  which 
mark  every  stage  of  fever,  that  this  function  of  the  corpuscles  is 
impaired  from  the  first.  This  is  indicated  by  the  besom  de  respirer 
developed  in  the  premonitory  stage;  the  sensation  and  condition  of 
the  respiratory  organs  are  precisely  the  same  as  if  their  capacity 
had  been  diminished,  and  due  aeration  of  the  blood  thus  prevented. 
The  patient  takes  many  forced  inspirations,  sighs,  or  gasps,  and  the 
breathing  is  quickened  on  the  least  exertion.  The  hasmato-globuline 
is  changed  also,  for  the  skin  assumes  a  peculiarly  pale,  sallow,  and 
unhealthy  look.  The  function  of  the  nervous  system  is  impaired 
in  consequence  of  these  changes  in  the  blood,  namely,  the  changes 
effected  by  the  poison  and  the  defective  oxygenation  —hence  lassi 
tude  and  weariness,  disturbed  functions,  or  congestion  of  some  or 
all  of  the  viscera,  and  a  lower  temperature."1 

From  all  that  precedes,  it  follows  that  in  uncomplicated  pneu 
monia,  we  have  febrile  reaction  attended  necessarily  with,  and 
depending  on,  local  inflammation  of  the  lungs — which  fever  is  ac 
companied  with  an  increase  of  fibrin  in  the  blood.  In  the  autumnal 
(as  also  in  other)  pyrexias  we  have  likewise  fever;  but  unlike  what 
occurs  in  the  former,  this  fever  is  not  necessarily  attended  with 
symptoms  of  local  inflammation,  and  is  characterized  by  a  defibrin- 
ated  condition  of  the  blood.  This  defibrinated  condition  of  the 
blood,  and  the  symptoms  accompanying  it,  many  of  which  it  serves 
to  explain,  are  analogous  to,  or  resemble,  those  produced  by  the 
introduction  of  putrid  or  poisonous  matters  into  the  circulation ; 
whilst  the  opposite  condition  of  the  same  fluid  in  pneumonia  serves 
to  explain  the  symptoms  by  which  this  disease  is  attended,  and  would 
be  totally  incapable  of  accounting  for  those  that  are  characteristic 

1  Brit,  and  For.  Med.-Chir.  Rev.  iii.  95,  96. 
24 


370  PNEUMONIA    AND 

of  idiopathic  fever ;  at  the  same  time  that  it  could  not  in  any  con 
tingency  be  the  result  of  a  poisonous  agent  thrown  into  the  circula 
tion.  Can  any  one,  with  such  facts  before  him,  seeing  an  increase 
of  fibrin  on  the  one  hand,  and  a  diminution  of  the  same  element 
on  the  other,  unite  in  sentiment  with  those  who  regard  the  two 
diseases  as  pathologically  identical,  and  maintain  with  them  that 
pneumonia  is  really  and  substantially  nothing  more  than  a  peculiar 
form  of  remittent  and  intermittent  fever?  In  other  words,  can  he 
be  persuaded  that  a  peculiar  disease,  characterized  by  a  particular 
condition  of  the  blood,  and  depending  for  its  existence  on  the  local 
inflammation  of  a  special  organ,  is  only  a  different  form  of  another 
disease,  marked  by  a  diametrically  opposite  condition  of  that  fluid, 
and  not  necessarily  connected  with  the  inflammation  of  that,  or  any 
other  organ  ? 

Odour  of  the  surface  peculiar  in  some  malarial  diseases ;  not  so  in 
pneumonia. — Nor  do  we  find  that  the  two  diseases  approximate 
much  more  closely  in  respect  to  the  odour  emitted  by  the  sick. 
In  pneumonia,  as  in  other  kindred  inflammations,  the  odour,  apart 
from  that  which  accompanies  ordinary  perspiration  consequent  on, 
or  occurring  during  or  at  the  close  of  the  stage  of  febrile  excite 
ment — more  frequently  at  the  period  of  crisis — or  from  that  which 
depends  on  the  peculiar  complexion  of  the  patient,  or  the  particular 
idiosyncrasy  he  may  possess,  presents  nothing  unusual,  and  apper 
taining  in  a  special  manner  to  the  disease ; — nothing  which  is  not  seen 
every  day  in  other  and  dissimilar  febrile  complaints — nothing  which 
may  serve  to  impart  to  the  case  a  particular  pathogenic  character. 
If  this  does  not  hold  good  in  all  cases,  the  exceptions  occur  principally 
in  the  typhoid  form  of  the  disease,  or  when  the  case,  though  not  ori 
ginally  of  that  kind,  fulls  into  a  low  malignant  condition ;  or  they 
occur  when  the  pneumonia  is  complicated  db  initio  with  some  dis 
ease  in  which  the  phenomenon  commonly  shows  itself;  but,  in  such 
instances,  the  fetid  odour  emitted  belongs  to  that  typhoid  condition, 
or  to  the  other  complaint  superadded  to  the  thoracic  inflamma 
tion,  and  not  to  the  latter  itself.  If,  now,  we  pass  from  this  disease 
to  the  malarial  pyrexios,  we  shall  find  that  in  these,  particularly  in 
the  advanced  stages,  and  in  the  malignant  forms,  the  odour  of  the 
surface  constitutes  frequently  a  prominent,  and,  as  it  were,  a  cha 
racteristic  symptom,  which,  considering  the  connection  between  the 
odour  of  the  blood  and  that  of  the  skin  in  the  state  of  health,  may 


AUTUMNAL    FEVERS.  371 

be  presumed  to  arise  from  that  imparted  to  the  circulating  fluid 
by  the  malarial  poison.  We  may  even  go  so  far  as  to  aver,  that 
each  variety  of  malarial  fevers  presents  something  peculiar  in  that 
respect,  which,  while  enabling  the  pathologist  to  distinguish  it 
from  pneumonia  and  other  true  phlegmasias,  affords  him  the  means 
of  pointing  out,  to  a  certain  extent,  at  least,  the  particular  nature  of 
the  case  under  examination,  or  the  class  to  which  it  belongs.  Speak 
ing  of  the  second  period  of  the  Niger  fever,  Dr.  Me  Williams  says : 
"  The  principal  complaint  at  this  period  was  from  the  odour  of  the 
perspiration,  particularly  in  those  cases  that  subsequently  proved 
fatal.  I  was  not  sensible  of  this  peculiarity  in  the  smell  of  the  per 
spiration  in  my  own  case,  but  I  perceived  it  very  distinctly  in 
several  others."1  In  the  bilious  remittent  fevers  of  Ceylon  and  the 
West  Indies,  a  peculiar  smell  emitted  by  the  sick  is  alluded  to  by 
Dr.  Millingen,  and  other  writers.2 

In  the  yellow  fever,  a  peculiar  odour  is  described  as  being  of  still 
more  common  occurrence.  I  am  aware  that  many  writers  on  the  dis 
ease  as  it  shows  itself  in  tropical  and  temperate  regions,  have  taken  no 
notice  of  this  symptom;  and  that  there  are  not  wanting  those  who 
have  expressed  doubts  as  to  its  occurrence,  or  even  denied  it  alto 
gether.  Dr.  Townsend,  for  example,  in  his  account  of  the  epidemic 
of  New  York  in  1822,  says  that  there  was  not,  at  any  time,  as  far 
as  his  experience  goes,  a  foul  cadaverous  effluvium  from  the  body, 
"  a  symptom  so  peculiarly  characteristic  of  typhus,  with  which  yel 
low  fever,  however,  ought  not  to  be  confounded.  On  the  contrary, 
in  a  majority  of  cases,  everything  about  the  patient  seemed  perfectly 
inodorous,  and  for  hours  after  death."3  Dr.  Tally  also,  in  speaking  of 
the  fever  of  Middletown,  Conn.,  in  1820,  informs  us  that,  in  general, 
there  was  but  little  fetor  before  death,  and  even  the  usual  febrile 
smell  was  not,  in  many  instances,  perceptible.4 

But  whatever  may  have  been  the  case  in  New  York  and  Middle- 
town,  at  the  periods  in  question,  and  in  other  instances  that  might, 
if  necessary,  be  mentioned,  and  however  true  it  may  be  that  from 
these  facts  and  the  silence  of  several  writers  on  the  subject,  we  may 
infer  that  the  surface  of  the  body  in  the  yellow  fever  does  not 

1  Op.  tit.  loo. 

2  Second  Report  of  London  Board  of  Health.  364;  James  Clark,  Fever  of.  Domi 
nica,  20. 

3  Op.  tit.  105. 

4  Essays  on  Fevers  and  other  Medical  Subjects,  &c.  30. 


372  PNEUMONIA    AND 

invariably  emit  an  odour  of  a  peculiar  kind;  jet  facts  sufficient  may 
be  gathered  from  the  writings  on  this  disease,  in  both  temperate  and 
tropical  regions,  to  bear  me  out  in  what  is  here  stated,  and  to  show, 
not  only  that  the  symptom  in  question  occurs  often,  but  does  so 
under  circumstances  calculated  to  induce  us  to  view  it  as  pathog- 
nomonic  of  the  fever  generally.  I  cannot  doubt  having  recognized 
a  peculiar  and  offensive  odour  about  the  persons  of  individuals 
affected  with  this  disease;  and  I  think  it  has  enabled  me,  in  some 
instances,  to  establish  a  correct  diagnosis.  In  one  or  two  cases 
the  smell  was  highly  offensive.  It  has  been  noticed  in  all  our 
epidemics.  Dr.  Deveze1  speaks  of  it  as  of  frequent  occurrence 
in  the  latter  stages  of  the  disease,  and  designates  it  as  fetid — um 
odeur  infecte.  Dr.  Bush2  states  that,  in  1793,  the  sweats  in  some 
persons  had  an  offensive  smell  resembling  that  of  the  washings  of  a 
gun.  This  odour  was  emitted  by  those  who,  though  not  ill  of  the 
fever,  were  exposed  to  the  prevailing  cause.  It  was  perceived  even 
in  those  cases  in  which  the  disease  went  off  on  the  first  day  of  the 
attack.3  In  his  history  of  the  epidemic  of  1794,  the  same  eminent 
physician  says:  "I  recollect  having  more  than  once  perceived  a 
smell  which  had  been  familiar  to  me  during  the  prevalence  of  the 
yellow  fever  in  1793.  It  resembled  the  smell  of  liver  of  sulphur. 
I  suspected  for  awhile  that  it  arose  from  the  exhalations  of  the  gut 
ters  of  the  city.  But  an  accident  taught  me  that  it  was  produced 
by  the  perspiration  of  my  body.  Upon  rubbing  my  hands,  this 
odour  was  increased  so  as  to  become  not  only  more  sensible  'to 
myself,  but  in  the  most  sensible  degree  to  my  pupil,  Mr.  Otto. 
From  this  fact,  I  was  convinced  that  I  was  strongly  impregnated 
with  miasmata."4  Dr.  S.  Jackson  mentions  that  in  one  case  a  most 
intolerable  fetor  proceeded  from  the  patients  body  for  twenty-four 
hours  before  his  entire  and  complete  dissolution.5  Drysdale,6  in 
Baltimore ;  Hill,7  in  Wilmington,  .North  Carolina ;  Gros,8  in  New 
Orleans;  Stone,9  in  Woodville  and  Natchez;  Dr.  A.  Hosack,  in  New 
York;10  Dr.  Manson,11  in  New  Haven,  have  made  similar  observa 
tions  during  the  epidemics  they  describe. 

I  Traite  de  la  F.  J.  26.  2  Op.  tit.  iii.  85. 
3  Ibid.  iii.  03.  «  Ibid.  iii.  217. 

5  Fever  of  1820,  p.  54.  6  Med.  Mus.  i.  137. 

7  Med.  Recorder,  v.  90.  8  Rep.  on  Fever  of  1817,  N.  0.  12. 

9  Y.  F,  of  New  York  in  1795,  p.  1C.  10  Webster's  Collection,  182. 

II  N.  0.  J.  ii.  180;  ibid.  v.  453. 


AUTUMNAL    FEVERS.  373 

Speaking  of  the  fever  of  Woodville  (1844),  Dr.  Stone  remarks : 
"  Sometimes  before,  and  always  after  an  attack,  and  not  dependent 
upon  the  perspiration,  a  peculiar  odour  was  perceptible,  which  it  is 
not  easy  to  describe ;  but  which  to  have  observed  once  is  to  remem 
ber  always ;  I  think  I  could  detect  the  disease  by  this  alone.  One 
of  my  children,  aged  eight  years,  gave  off  this  odour  twelve  days 
before  the  development  of  fever."  Besides  this,  the  perspiration 
was  of  an  offensive  odour.  Of  the  symptom  under  present  consider 
ation,  as  it  presented  itself  four  years  after  in  Natchez,  the  same 
writer  says:  "An  odour  which  I  cannot  describe,  but  which  was 
the  odour  that  had  been  indelibly  impressed  on  me  in  1844,  was 
strongly  perceptible  in  many  of  the  simplest  cases  towards  the  latter 
part  of  the  epidemic,  but  which  I  did  not  notice  for  a  month  after 
its  commencement."  On  this,  as  on  the  former  occasion,  the  "per 
spiration  was  always  offensive,  often  fetid." 

In  the  yellow  fever  epidemics  of  Leghorn,  and  of  various  parts 
of  the  South  of  Spain,  the  same  symptom  was  frequently  observed, 
and  is  specially  noticed  in  the  numerous  accounts  of  them  which 
we  possess.  In  the  first-named  city,  the  fetor  was  compared  to  that 
of  fetid  bile.1  Arejula,2  at  Malaga,  in  1803,  likened  it  to  the  smell 
of  putrid  fish.  It  is  mentioned  by  the  same  writer,  Berthe,3  and 
others,  as  of  common  occurrence  during  the  epidemics  of  Anda 
lusia,  from  1800,  and  1810.  Martel,4  in  describing  the  disease  as 
it  occurred  among  the  French  soldiers  in  1811,  at  Eotana,  Lev- 
r'illa,  and  Alcantarilla,  lays  great  stress  on  that  symptom.  Dr. 
E.  Jackson5  informs  us  that,  at  Cadiz  and  Xeres,  in  1820,  the 
fetor  emitted  by  the  body  of  the  sick,  in  some  forms  of  the  dis 
ease,  was  singular  —  sickly  and  faint,  and  not  unlike  the  smell 
of  a  fish-market.  The  next  year,  at  Barcelona,  Pariset6  and  his 
colleagues  noticed  a  cadaverous  odour  in  some,  though  not  gene 
rally.  Audouard7  mentions  it  as  of  frequent  occurrence ;  so  does 
Lafuente,8  and  other  Spanish  writers.  Rochoux9  states  that  some 
of  the  sick  emit  a  very  offensive  odour,  analogous  to  that  of  gan 
grene  ;  and  adds  that  it  is  a  usual  attendant  on  the  cutaneous  exhala- 

1  Eilinb.  Journ.  ii.  84.  2  Ibid.  i.  448. 

3  Op.  fit.  55,  50.  4  Quoted  by  Bally,  250. 

5  Epid.  Y.  F.  of  the  South  Coast  of  Spain,  105.     6   Op.  cit.  435. 

7  Op.  cit.  211,  393. 

8  Observnciones  sobre  la  Fiebre  Amarilla,  &c.  Pcriodico  de  la  Soc.  Med.  Cir.  i.  1G5. 
(See  Mochoux,  472.) 

9  Rochoux,  op.  cit.  461,  472,  473. 


374  l»NEf MOtflA    AtfD 

tion,  whether  the  latter  assumes  the  character  of  sweat  or  of  insensi* 
ble  perspiration.  "It  is  not,"  he  adds,  "so  strong  as  to  be  perceived 
from  the  street,  as  some  physicians  have  asserted ;  but  we  never  fail  to 
be  struck  with  it  when  we  uncover  a  patient  and  approach  very  near 
him.  It  is  of  an  insipid  nature  (fade),  somewhat  nauseous,  and 
adheres  strongly  to  clothes."  The  same  writer  remarks,  in  ad 
dition,  that,  on  this  point,  the  yellow  fever  approximates  closely  to 
hospital  typhus,  and  the  plague,  both  of  which  are  characterized  by 
a  peculiar  odour. 

Nor  is  this  all;  Desportes,1  more  than  a  century  ago,  noticed  the 
same  phenomenon  in  the  fever  of  St.  Domingo,  where  it  was  sub 
sequently  observed  by  Bally2  and  Gilbert,3  the  former  designating 
it  as  fetid,  the  latter  as  cadaverous.  Dr.  E.  Jackson4  found  in  the 
West  Indies,  as  he  did  in  the  fever  of  Europe,  cases  in  which  the 
perspiration  had  a  peculiar  smell,  resembling  that  of  a  fish-market. 
In  the  fever  of  Dominica,  as  we  learn  from  Dr.  Imray,5  the  odour 
of  the  cutaneous  exhalation  was  often  extremely  disagreeable  as 
well  to  the  patient  himself  as  his  attendants.  Additional  testimony 
on  this  subject  might  be  gathered  from  the  writings  of  Gillespie 
(34),  Savaresi  (273,  4),  Madrid  (25),  Yatable  (346),  Frost  (Med.  Re- 
pos.  xiii.  33),  Comrie  (Ed.  J.  xiii.  177),  Ealph  (Ed.  Med.-Chir.  Tr.  ii. 
75),  Arnold  (10). 

The  condition  of  the  urine  different  in  the  two  diseases. — It  may  not 
be  improper  to  call  attention,  in  this  place,  to  the  condition  of 
the  urine  in  the  two  diseases.  As  is  known,  this  fluid  in  its  normal 
state,  contains,  on  an  average,  11.88  of  urea,  0.395  of  uric  acid, 
6.80  of  inorganic  salts,  and  8.60  of  organic  matter.  Of  the  salts, 
the  chloride  of  sodium  may  be  estimated  at  from  ^'gJJ  parts  to 
f'jfjf  in  1,000.  Now  when,  with  this  before  us,  we  inquire  how 
matters  stand  in  respect  to  malarial  fevers  and  pneumonia,  we  find 
that  these  diseases  differ  in  no  inconsiderable  degree  from  each  other 
and  from  the  state  of  health,  so  far  as  the  proportionate  quantity 
of  those  ingredients  is  concerned.  In  the  former  the  urea  is  in 
less  quantity  than  in  health,  presenting  a  proportion  of  only  9.01. 
At  the  same  time,  the  quantity  of  uric  acid  attains  an  amount  of 
9.80,  or  eight  times  larger  than  in  health.  As  regards  the  inorganic 

1  Maladies  de  St.  Domingues,  i.  221.  2  Typhus  d'Amerique,  247,  248. 

3  Hist.  Med.  de  1'Armee  Frar^aise  a  St.  Domingue,  6(5. 

4  Sketch,  i.  04.  5  Edinb.  Med.  and  Surg.  Journ.  liii.  80. 


AUTUMNAL   FEVERS.  375 

salts,  we  find  them  to  rise  as  high  as  about  16.72,  or  much  more 
than  twice  as  high  as  in  healthy  urine,  while  the  organic  matter 
varies  but  slightly,  if  at  all,  from  the  normal  state.  As  a  matter 
of  course,  amid  this  increase  in  the  salts,  the  chloride  of  sodium 
can  suffer  no  diminution,  and  in  all  probability  has  increased  in 
the  same  ratio  as  the  other  salts.1  During  the  stage  of  apyrexia 
in  intermittent  fever,  the  urine  is  often  found,  so  far  as  the  above 
ingredients  are  concerned,  in  its  natural  state  :  a  condition  propor 
tioned  in  great  measure  to  the  extended  duration  of  that  stage  and 
the  shortness  of  the  febrile  paroxysm.  In  some  cases  the  fluid  is 
healthy  throughout.  But  in  most  instances  the  changes  under  con 
sideration  exist  as  well  in  the  intermissions  as  during  the  parox 
ysms,  and  are  greater  in  proportion  to  the  length  of  the  disease. 
In  no  instance  can  we  discover  that  the  proportion  of  uric  acid 
remains  at  the  normal  point,  and  that  the  quantity  of  the  fixed  salts 
falls  considerably  below. 

In  reference  to  the  phlegmasiae,  and  pneumonia  in  particular,  the 
proportions  are  nearly  reversed ;  for  Simon  and  other  high  che 
mical  authorities  have  shown  that  the  urine  therein  exhibits  a 
marked  diminution  of  the  inorganic  salts,  and  a  greater  relative 
amount  of  organic  constituents ;  the  proportion  of  the  ingredients 
mentioned  being  urea,  7.3  ;  uric  acid,  0.4 ;  fixed  salts,  2.7  ;  and  or 
ganic  matter,  8.8.2  In  an  examination  by  Becquerel  (op.  cit.  329), 
the  following  proportions,  which  differ  but  little  from  the  preceding, 
were  obtained  :  urea,  7.761 ;  uric  acid,  0.464 ;  inorganic  salts,  2.871 ; 
organic  matter,  9.332.  Of  the  salts,  the  chloride  of  sodium  was 
early  found  to  suffer  a  greater  diminution  than  the  others  in  all  the 
phlegmasiae.  Subsequent  observations,  made  some  three  years  ago 
by  Dr.  Redteiibacher,  leave  no  doubt  that,  in  pneumonia,  the  result 
in  question  is  still  more  marked  and  constant  than  in  inflammation 
of  other  organs ;  for  while  in  these  the  chloride  is  usually  only  greatly 
diminished,  and  sometimes,  indeed,  preserves  its  normal  proportions, 
in  pneumonia  the  quantity  of  the  salt  never  fails  to  diminish  gra 
dually  until  the  period  of  hepatization  has  occurred,  when  no. traces 
of  it  can  be  detected  in  the  urine,  and  only  makes  its  appearance 
again  as  the  resolution  of  the  inflammation  proceeds.  It  may  be 
remarked  that  this  effect  cannot  be  due  solely  to  the  altered  diet 

1  Becquerel,  Semeiotique  cles  Urines,  256-291 ;  Heretier,  Cbiuiie  Med.  528 ;  Simon, 
op.  cit.  ii.  255-257. 

2  Simon,  op.  cit.  ii.  216. 


376  PNEUMONIA    AND 

taken  by  patients  labouring  under  the  disease,  for  other  inflamma 
tions  require  the  same  diet,  and  we  have  just  seen  that  in  them  the 
phenomenon  often  fails  to  present  itself.1 

By  Mr.  Beale,  of  London,  the  subject  has  been  recently  taken  up 
and  apparently  examined  with  considerable  care;  and  from  his 
researches  in  the  matter,  he  arrives  at  the  following  conclusions : — 

1.  That  in  pneumonia,  there  is  a  total  absence  of  chloride  of 
sodium  from  the  urine,  at  or  about  the  period  of  hepatization  of 
the  lung. 

2.  That  soon  after  the  resolution  of  the  inflammation,  the  chloride 
becomes  restored  to  the  urine,  and  often  in  considerable  quantity. 

3.  That  at  this  period  the  serum  of  the  blood  is  found  to  contain 
a  greater  amount  of  chloride  than  in  health. 

4.  That  the  presence  of  chloride  of  sodium  in  the  urine  may  be 
taken  as  evidence  of  the  existence  of  a  greater  quantity  of  the  salt 
in  the  blood,  than  is  required  for  the  wants  of  the  system  gene 
rally,  or  at  least  of  an  amount  sufficient  for  that  purpose ;  and  that 
the  absence  of  the  salt  from  the  urine  indicates  that  the  circulating 
fluid  contains  less  than  the  normal  quantity. 

5.  That  the  sputa  in  pneumonia  contain  a  greater  quantity  of 
fixed  chloride  than  healthy  pulmonary  mucus,  if  there  be  not  much 
less  than  a  normal  amount  in  the  blood,  although  there  be  a  com 
plete  absence  of  the  salt  from  the  urine.     In  all  cases,  however, 
there  is  found  in  the  sputa  a  quantity  many  times  greater  than 
exists  in  an  equal  amount  of  blood  at  the  same  period  of  the  dis 
ease.     The  absolute  amount  present  is  subject  to  variation  at  dif 
ferent  periods  of  the  disease,  and  in  different  cases. 

6.  That  there  is  reason  to  believe  that  the  absence  of  the  chloride 
of  sodium  from  the  urine  during  the  stage  of  hepatization,  depends 
upon  a  determination  of  this  salt  to  the  inflamed  lung,  and  that, 
when  resolution  occurs,  this  force  of  attraction  ceases,  and  what 
ever  salt  has  been  retained  in  the  lung  is  reabsorbed,  and  appears 
in  the  urine  in  the  usual  way.2 

Here,  then,  we  perceive  a  strong  contrast  existing  between 
pneumonia  and  malarial  fevers — increase  of  urea  in  the  one,  and 
diminution  of  the  same  in  the  other  disease  ;  diminution  of  uric 
acid  in  the  former,  and  great  increase  in  the  latter;  diminution  of 
the  salts  in  the  one,  great  increase  of  them  in  the  other ;  consider 
able  diminution,  and  finally  total  absence  of  the  chloride  of  sodium 

1  Edinb.  J.  Ixxx.  246.  2  Med.-Chir.  Trans,  xxxv.  355,  &c. 


AUTUMNAL   FEVERS.  377 

in  the  one,  increased  or  normal  quantity  of  the  same  in  the  other 
disease ;  finally,  vast  increase  of  organic  matter  in  the  former, 
ordinary  quantity  of  it  in  the  latter.  To  this,  let  it  be  added  that 
when  in  malarial  fevers  results  of  an  opposite  nature  are  obtained? 
they  will  be  found  due  to  an  inflammatory  complication. 

But  I  have  sufficiently  enlarged  upon  these  topics.  Nor  shall  I  do 
more  than  refer  to  the  peculiar  acid  alliaceous  odour  of  the  breath, 
which  has  been  regarded,  justly  no  doubt,  as  among  the  character 
istics  of  yellow  fever;1  the  pearly  appearance  of  the  gums  in  the 
same  disease,  to  which  attention  was  first  called  by  Dr.  Yaletti,  of 
New  Orleans  ;  to  the  peculiar  indentation  at  the  roots  of  the  nails, 
"  indicating  the  point  at  which  their  growth  was  suspended  by  the 
disease ;"  observed,  it  is  said,  in  1847,  by  Dr.  Walkly,  of  Mobile, 
in  all  the  forty -one  cases  he  examined  ;2  or  to  the  bluish  discolora 
tion  of  the  gums  said  to  be  peculiar  to  all  malarial  diseases.  These 
subjects  have  not  yet  been  examined  to  a  sufficient  extent  to  be 
used  in  this  place  for  purposes  of  comparison. 

Anatomical  characters  different  in  the  two  diseases. — Nor  is  the  dis 
crepancy  less  marked  in  regard  to  the  anatomical  characters  of  the 
two  diseases.  In  the  one,  there  is  often  no  traces  of  inflammation, 
properly  so  called.  When  these  do  present  themselves,  they  are 
seated  in  the  gastro-intestinal  surface ;  sometimes,  though  not 
always,  in  the  cerebral  organs  and  membranes,  and  occasionally  in 
the  liver.  As  frequently,  these  organs  are  only  congested.  Usu 
ally,  the  liver  is  neither  inflamed  nor  greatly  congested,  being  in 
some  forms  of  fever  (the  bilious  remittent)  of  a  bronze  hue,  depend 
ing  on  the  deposit  of  a  dark  mela3nic  pigment,  not  unlike  the  dark 
solid  substance  of  black  vomit.  It  does  not  contain  a  larger  quan 
tity  than  natural  of  fatty  matter,  but  is  filled  with  bile.3  In  another 
form  of  malarial  fever — the  yellow — the  organ  is  of  a  pale  yellow 
colour,  and  dry  anemic  texture.  It  bears  the  marks  of  having  se 
creted  little  or  no  bile  during  the  course  of  the  attack,4  and  has  been 
shown  by  Dr.  A.  Clark,  of  New  York,  whose  discovery  was  fully 

1  Kelly,  Am.  J.  xiv.  (N.  S.)  374.  2  N.  0.  J.  v.  481. 

3  Brit,   and  For.   Med.-Cli.   Rev.  Jan.  1849,  pp.   95.  96.     Stewardson,  Am.  J.   (N. 
S.),  i.   313;   Swctt,  ib.  iii.   83,  35;  Anderson  and  Frick,  ib.  xi.   332;   Anderson  (of 
Alabama),  Prize  Essay,  Proceedings  of  Alabama  Medical  Association,  1852,  p.  117. 

4  See  Louis  on  Yellow  Fever,  and  mai^  other  works  on  the  same  disease. 


378  PNEUMONIA    AND 

confirmed  during  the  last  autumn  in  Philadelphia,  to  contain,  and 
to  owe  its  peculiar  hue,  to  the  deposit  in  the  hepatic  cells  of  a  large 
quantity  of  oily  or  fatty  matter,  which,  in  some  cases,  imparts  to 
the  organ  much  of  the  characteristic  appearances  of  a  common 
fatty  liver.  The  spleen  is  usually  found  congested,  softened,  or 
enlarged,  or  even  hypertrophied.  This  condition  of  the  organ 
appertains  more  specially  to  the  intermittent  and  remittent  forms 
of  malarial  fevers,  and  has  been  noted  universally  in  this  country, 
in  France,  England,  Holland,  Algeria,  India,  and,  indeed,  in  every 
country  where  these  diseases  prevail,  and  where  dissections  have 
been  performed.  It  is  noted  also  in  typhoid,  and  in  the  relapsing 
fever  of  the  British  islands — so  frequently,  indeed,  as  to  be  viewed 
in  the  light  of  a  characteristic  phenomenon.1  Finally,  the  blood 
in  general  is  found  altered  in  colour,  often  more  or  less  fluid,  and 
exhibiting,  in  malignant  cases,  signs  of  decomposition.  But  amid 
all  these  changes,  the  lungs  remain  unimplicated ;  or,  if  otherwise, 
the  occurrence  is  rare,  and  differs  in  nothing  from  what  is  seen  in 
other  acute  diseases  not  especially  seated  in  those  organs. 

Here,  then,  we  perceive  that  neither  this  affection,  nor  any  local 
inflammation,  nor  a  buffy  or  cupped  blood  form  part  and  parcel  of 
autumnal  fevers  during  life,  or  leave  traces  after  death.  In  the 
other  disease,  on  the  contrary — pneumonia — the  lungs  never  fail  to 
present  marks  of  inflammation,  varying  in  character  according  to 
the  stage  at  which  the  disease  had  arrived;  and  while  such  changes 
are  necessarily  and  invariably  detected  in  those  organs,  the  stomach, 
bowels,  liver,  and  spleen  are  very  usually  found  in  their  normal 
state.  In  fact,  no  sign  observed  during  life,  no  anatomical  character 
discovered  after  death,  can  be  adduced  in  evidence  of  the  pathologi 
cal  identity  of  those  diseases,  or  induce  us,  for  a  moment,  to  think 
they  arise  from  the  same  cause.  In  the  one  case,  the  latter  consists 

1  Cleghorn,  84  (5th  eel.);  Monfalcon,  208,532;  Addison,  Lond.  Med.  Gaz.  xxiii. 
796  ;  Forbes's  Rev.  xviii.  189  ;  Tweedy,  33,  Am.  ed.  ;  Copland,  ii.  1089  ;  Henderson, 
Edinb.  J.  lix.  ;  Dickson,  Charleston  J.  i.  20;  Am.  J.  July,  1852  ;  Drake,  i.  830,  842; 
Swett,  Am.  J.  (N.  S.)  iii.  33,  35;  Stewardson,  Am.  J.  (X.  S.)  i.  314  ;  Bartlett,  332  ; 
Anderson  and  Frick,  Am.  J.  (N.  S.)  xi.  332;  Haspcl,  Mai.  de  1'Algerie,  ii.  201,  317; 
J.  Davy,  ii.  230;  Williams,  ii.  470;  II.  Jackson,  i.  80;  Boudin,  Gdographia  Med.  40; 
Cycl.  of  Pract.  Med.  ii.  223 ;  Twining,  Fevers  of  Bengal ;  Boyle,  Dis.  of  West  C.  of 
Africa,  89,  141,  140;  Durand,  Mem.  &c.,  sur  les  rates  engorgees  pendant  les  f.  Interm. 
0;  Bryson,  73;  Evans,  221  ;  Marshall,  Top.  and  Dis.  of  Ceylon,  142;  Watson,  455; 
Anderson,  loc.  cit.  117;  Ncpple,  F.  I.  61,  270;  Audouard,  Bulletin,  xii.  151;  C. 
Broussais,  ib.  293;  Corney,  ib.  624;  Maillot,  285;  Bonnet,  214;  Bailly,  102,  &c. 


AUTUMNAL   FEVERS.  379 

chiefly  in  some  irregular  mode  of  application  of  common  atmospheric 
influences,  which  operate  by  occasioning,  after  a  comparatively 
short,  or  even  without  any  visible  sedation,  an  inflammatory  reac 
tion  in  the  organ  affected,  as  also  secondarily  in  the  system  at  large. 
In  the  other  case,  the  cause  consists  evidently  of  a  peculiar  poisonous 
matter  floating  in  the  atmosphere;  the  primary  and  prominent 
effects  of  which  are  subduction  of  the  vital  or  nervous  power,  dimi 
nution  of  vascular  action,  prostration,  to  a  greater  or  less  extent,  of 
all  the  energies  of  life,  and,  as  a  consequence,  of  the  vital  affinity 
and  cohesion  of  the  soft  solids  and  contamination  of  the  circulatory 
and  secretory  fluids.  These  are  doubtless  attended,  in  the  early  stage 
of  the  milder  cases  and  less  violent  forms,  with  symptoms  of  reac 
tion,  as  well  as  with  a  functional  derangement  of  important  organs ; 
but  often  this  reaction  is  broken  or  imperfect;  and  frequently  the  dis 
ease  is  characterized,  throughout  its  whole  progress  by  symptoms  of 
prostration.  In  a  word,  we  perceive  effects  which  bear,  in  the  more 
severe  and  malignant  forms  of  the  disease  especially,  a  close  analogy 
to  those  occasioned  by  other  and  more  tangible  toxical  agents.  Like 
some  of  these,  as  oxalic  acid  or  nicotine — the  malarial  and  several 
other  zymotic  poisons,  sometimes  suddenly  prostrate  the  system  to 
the  verge  of  the  grave,  or  even  destroy  life  in  a  few  hours  and  during 
the  first  access,  or,  as  Dr.  Simon  says,  in  the  tremendous  shock  and 
depression  thereby  occasioned  in  the  system.  So  rapidly  destruc 
tive,  indeed,  is  the  effect,  that  were  it  not  for  concomitant  circum 
stances  it  would  often  be  difficult  to  form  an  idea  of  the  real  nature 
of  the  case.  The  narcotico-irritating  quality  of  the  poison  is  fully 
indicated  by  the  phenomena  of  the  opening  stage  of  fever,  for  this 
is  marked  by  a  reduction  of  vital  energy,  obtuseness  of  sensibility, 
suspended  or  perverted  secretion,  and  diminished  calorification.  As 
Dr.  Drake  remarks :  "  We  may  assure  ourselves  that  its  first  effects 
will  not  be  increase,  but  depression  of  excitement,  by  referring  to 
the  constitutional  influence  of  foreign  matters,  liquid  or  gaseous, 
when  introduced  into  one  of  the  serous  membranes  (as  the  peri 
toneum,  for  example)  which  are  always  those  of  depression  as  well 
as  irritation."1 

It  may  not  be  amiss  to  remark,  while  on  this  subject,  that  parox 
ysms  of  febrile  excitement,  assuming  a  periodic  type,  and  which, 
though  not  identical  with,  bear  some  analogy  to,  various  forms  of 

1  Op.  dt.  733. 


380  PNEUMONIA    AND 

malarial  fevers,  are  not  unfrequently  produced  by  agencies  of  a 
debilitating  character,  even  though  the  localities  where  they  occur 
are  free  from  periodic  fever;  and  we  know  that  in  paludal  or  fever 
districts,  attacks  of  the  disease  are  sure  to  be  brought  on  by  the 
application  of  such  agencies,  and  that  experience  has  taught  the 
necessity  of  avoiding,  in  such  districts,  a  mode  of  living  calculated 
to  place  the  system  below  par.  Of  the  first  of  these  causes,  one 
example  will  suffice.  M.  Eenouard  communicated  to  the  Academy 
of  Medicine  of  Paris,  in  1847,  an  account  of  several  cases  in  which 
periodic  paroxysms  of  fever  were  produced  in  a  non-malarial  locality 
by  copious  losses  of  blood.  In  one  of  these  instances  the  disease 
produced  assumed  a  regular  tertian  type ;  in  two  others  the  fever 
was  remittent.  All  were  cured  by  a  tonic  and  quinine  treatment.1 

The  two  diseases  differ  widely  as  regards  the  duration  of  the  %)rocess 
of  incubation. — Other  reasons  may  be  adduced  in  support  of  the 
opinion  here  advocated.  In  one  of  these  diseases — periodic  or 
autumnal  fevers — the  period  of  incubation  or  latency,  i.  e.  the  period 
during  which  the  system  tolerates  the  poison,  and  the  latter  remains 
apparently  innocuous  until  reaction  is  brought  about  by  some  in 
trinsic  circumstance  of  the  depressing  kind  or  otherwise — though 
considered  as  very  short  by  Macculloch,2  Nepple,3  and  a  few  others, 
is  often  found  to  be  very  greatly  prolonged;  while  in  every  case  of 
pneumonia  the  morbid  effect  soon  follows  the  application  of  the 
cause.  The  yellow  fever  poison,  though  occasionally  rapid  in  its 
effects,  and  attacking  but  a  few  hours  or  days  after  exposure,  re 
mains  at  times  dormant  in  the  system  as  long  as  fifteen,  thirty,  or 
fifty  days.  In  one  case  mentioned  by  Blair  (69,  70),  the  period 
seemed  extended  to  four  months.  In  a  private  communication  to 
the  author,  Dr.  Merrill  states  that  during  the  epidemics  of  Natchez, 
which  he  witnessed,  the  period  of  incubation  occasionally  extended 
to  fifteen  days.  M.  Bertulus,  who  saw  the  disease  in  the  West 
Indies,  limits  the  period  to  from  three  to  eight  days,  and  affirms 
that  it  never  extends  beyond  three  weeks.4  Dr.  Stevens,  also,  who  is 
well  acquainted  with  the  true  yellow  fever,  which,  in  accordance  with 
his  views,  respecting  its  origin  and  nature,  he  denominates  African 
typhus,  states  that  it  never  produces  its  effects  previous  to  the  fourth 

1  Bulletin,  xii.  040.  2  An  Essay  on  Marsh  Fcv.  i.  20. 

3  Traite  do  la  F.  Int.  140. 

4  Mem.  sur  1' Intoxication  Miasmatique,  39 


AUTUMNAL   FEVERS.  381 

day,  and  that  ho  has  known  some  well-marked  cases  in  which,  the 
poison  being  applied  in  a  less  concentrated  form,  the  individuals 
were  not  attacked  until  twelve  days  had  elapsed  after  exposure.1 
From  all  the  facts  I  have  myself  been  enabled  to  collect,  I  am  of 
opinion  that,  though  sometimes  very  short,  and  at  others  very  long, 
the  period  of  incubation  in  yellow  fever  usually  varies  from  five  to 
ten  days. 

In  other  forms  of  malarial  fevers,  the  period  of  latency  is  seldom 
shorter  than  three  or  four  days.  In  general  it  extends  beyond  this, 
and  has  not  unfrequently  been  known  to  reach  a  limit  far  exceeding 
that  noticed  in  the  yellow  fever.  Our  lake  fever,  according  to  Dr.  Ste 
vens,  has  an  incubative  period  of  about  a  week ;  but,  when  the  poison 
is  concentrated,  an  attack  often  comes  on  as  early  as  the  third  day — 
never  sooner.2  In  the  epidemic  of  Naples,  in  1764,  the  disease  some 
times,  though  rarely,  broke  out  immediately  after  exposure.  In  the 
greater  number  of  instances,  the  poison  remained  latent  to  the  end 
of  the  first  week.3  Dr.  John  Hunter  states  that,  on  the  Watering  ser 
vice  in  the  West  Indies,  some  fell  sick  on  the  first  and  second  day ; 
others  embarked  and  were  seized  on  the  tenth  or  fourteenth  day,  or 
even  three  weeks  after  exposure.4  He  informs  us  that  the  Suffolk 
militia  were  called,  in  1793,  from  their  healthy  country  to  Hilson 
Barracks,  the  low,  marshy,  unhealthy  situation  of  which  is  pro 
verbial.  Twenty-two  died  before  they  left  at  the  end  of  June.  In 
July  the  regiment,  with  eleven  other  battalions,  encamped  at  Water- 
town,  near  Tunbridge  Wells.  One  hundred  sickened  soon,  out  of 
five  hundred,  with  fever.  Some  were  taken  ill  in  October,  or  four 
months  after  leaving  the  Ililson  Barracks.  The  18th  regiment,  in 
1783,  after  being  at  the  same  barracks  from  June  22  to  October  9, 
were  sent  to  Gibraltar.  There  were  then  sixteen  of  the  men  labour 
ing  under  ague.  While  at  Gibraltar,  though  the  regiment  was  only 
four  hundred  strong,  the  disease  spread  so  rapidly  among  them, 
that  by  May  the  cases  amounted  to  two  hundred  and  eighty  (in 
cluding  women  and  children),  of  whom  a  part  were  then  recently 
attacked  for  the  first  time.  Whilst  such  was  the  course  of  events 
in  this  ill-fated  regiment,  the  disease  did  not  exist  in  any  other  part 
of  the  garrison.5  Dr.  Hunter  adds  that,  "ships  returning  from  a 
warm  climate,  particularly  if  they  have  been  in  harbour  during  the 

1  Stevens  on  the  Blood,  235.  2  Op.  cit.  243. 

3  Sarcone,  Maladie  de  Naples,  ii.  73,  74.  *  Op.  cit.  153. 

5  Ibid.  327-334. 


382  PNEUMONIA    AND 

unhealthy  season,  have  many  of  their  men  taken  ill  of  the  remittent 
fever,  even  two  or  three  months  after  being  at  sea.1 

Some  of  the  British  soldiers  who  inhaled  the  pestiferous  atmo 
sphere  of  the  Walcheren  Marshes,  were  attacked  for  the  first  time 
in  healthy  situations  in  England — Colchester,  Woodbridge,  &c. — 
as  late  as  nioe  months  after  they  were  brought  back.2  The  follow 
ing  facts,  communicated  to  Dr.  Bancroft  by  Mr.  Nixon,  surgeon  to 
a  battalion  of  the  1st  Eegiment  of  Foot  Guards,  will  be  read  with 
interest.  The  battalion  landed  on  South  Beveland  on  the  2d  of 
August,  872  strong.  On  the  19th,  the  endemic  appeared  among 
the  men,  and  between  that  day  and  the  4th  of  September,  when  the 
men  embarked  for  England,  i.  e.  sixteen  days,  359  of  them  were 
attacked.  The  battalion  was  landed  at  Chatham  about  the  7th  or  8th 
of  September.  Many  of  the  men  continued  to  be  attacked  with 
endemic  fever,  so  that  by  the  8th  of  March,  1810,  only  117  of  the 
original  strength  had  escaped  the  disease  in  question.  Some  of  the 
117  men  were  attacked  with  intermittent  fever  as  late  as  the  middle 
of  the  month  of  June.3  Dr.  Ferrus,  a  distinguished  physician  of 
Paris,  relates  a  striking  instance  of  the  kind.  Three  hundred  men, 
of  the  old  Imperial  Guard,  to  which  he  was  surgeon  at  the  time, 
were  exposed  to  the  cause  of  autumnal  fevers  in  Breslau.  Many 
of  them  took  the  disease  ten  days  after  leaving  the  place ;  other 
cases  followed,  and  the  fever  became  general.  Dr.  Ferrus  himself 
was  attacked  six  months  after,  while  stationed  on  the  Niemen, 
where  no  disease  of  the  kind  prevailed,  and  at  a  period  when  the 
country  all  around  was  perfectly  healthy.4  Of  forty  cases  of  inter 
mittent  fever  which  occurred  on  board  the  II.  C.  ship  Barrosa,  in 
1832,  1833,  three  took  place  seventy  to  eighty  days  after  leaving 
England:  thirty-one  while  lying  at  Whampoa;  and  seven  from  two 
to  three  months  after  leaving  Canton,  and  ninety-three  days  after  the 
disease  had  ceased  in  the  ship.5  Labourers,  especially  the  Irish 
will  go  down,  for  harvest  work,  into  Lincolnshire,  and  bring  back 
the  seeds  of  ague  within  them,  and  yet  may  not  be  attacked  for 
weeks  or  months.5  M.  Boudin  calls  attention  to  a  fact  which  he  him- 

1   Op.  cit.  335. 

*  Bancroft  on  Yellow  Fever,  241,  304;  Elane  Diss.  i.  244;  Williams,  Morbid  Poi 
sons,  ii.  4G5. 

3  Bancroft,  307,  308,  note. 

4  Diction,  de  Mod.  xii.  G;   ibid.  2d  ed.  xviii.  GO. 

5  Peterson,  Med.  Gaz.  xv.  2GO.  6  Med.   Gaz.  xxviii.  3G5. 


AUTUMNAL    FEVEKS.  383 

self  noticed ;  that  regiments  that  had  returned  to  Marseilles,  where 
periodic  fevers  are  but  little  known,  from  the  malarial  districts  of 
Algeria  and  Corsica,  as  well  as  those  that  had  formed  part  of  the 
expeditionary  army  of  the  Morea,  continued  during  several  years 
(des  anntes  entires)  to  suffer  from  diseases  bearing   unequivocal 
marks  of  the  fevers  of  the  localities  they  had  left.1     Towards  the 
close  of  the  year  1843,  two  regiments  of  infantry  arrived  at  Cour- 
bevoie ;  the  one  (23d  Light  Infantry)  coining  from  a  northern  gar 
rison,  the  other  from  the  citadel  of  Strasburg,  where  malarial  fevers 
prevail  extensively.     The  two  regiments  occupied  the  same  bar 
racks,  performed  the  same  duties,  partook  of  the  same  fare,  and 
were  in  every  other  respect  on  the  same  footing.     Yet,  while  the 
first  of  these  regiments  suffered  from  typhoid  fever  and  pneumonic 
inflammations,  the  other  furnished,  for  more  than  a  year,  a  large 
number  of  intermittent  fever  cases.     The  disease  spread  to  several 
hundred  of  the  men,  and  spared  few — not  even  those  who  had  not 
had  it  during  their  stay  in  the  malarious  locality  whence   they 
came.2     A  similar  occurrence  was  observed  in  another  regiment 
(the  75th)  transferred  from  Strasburg  to  Versailles,  in  the  autumn 
of  1843.     In  December  of  the  year  following,  the  fever  was  still 
prevailing,  but  only  among  the  men  who  had  arrived  from  Stras 
burg;  the  new  recruits  remaining  free  from  the  disease.3     In  an 
other  essay,  M.  Boudin  remarks :  "  So  far  as  regards  myself,  after 
a  survey  of  the  numerous  observations  we  have  collected  in  France, 
at  periods  and  in  localities  exempt  from  periodic  fevers  among 
men  arriving  from  the  paludal  districts  of  Corsica,   Morea,   and 
Africa,   we  have  no   hesitation  in  declaring   that   the   period  of 
latency   of  the    malarial    intoxication    may   extend   to   eighteen 
months."4 

One  of  our  countrymen,  Dr.  L.  II.  Anderson,  of  Alabama,  in  his 
Prize  Essay,  already  referred  to,  states  that  he  was  himself  attacked 
in  the  city  of  Paris,  six  months  after  leaving  a  mountainous  dis 
trict,  with  an  intermittent  of  a  very  different  character  from  the 
fever  usually  observed  in  that  city.  The  remote  cause,  as  he 
remarks,  had  no  doubt  been  harboured  in  the  system  all  the  time, 
his  general  health  appearing,  notwithstanding,  for  three  months 
before  the  attack,  better  than  it  had  been  for  years.  The  exciting 

1  Annales  d' Hygiene,  xxxiii.  Go.  2  Loc.  cit.  64. 

3  Ibid.  65.  4  Boudin,  Geographic  Med.  64, 


384  PNEUMONIA    AND 

t 

cause,  Dr.  Anderson  thinks:  was  doubtless  the  bad  air  of  the  hos 
pitals,  dissecting-rooms,  &C.1 

Dr.  Lee  relates  the  case  of  an  officer  of  our  navy,  who  was  ex 
posed  several  years  before  to  the  highly  concentrated  miasm  which 
produced  the  fatal  endemic  among  the  residents  of  Thompson's 
Island,  on  the  Florida  coast.  Although  he  escaped  the  bilious 
remittent,  which  proved  so  fatal  to  many  others,  he  yet  had  occa 
sional  attacks  of  genuine  intermittent,  for  several  years  afterward, 
on  exposure  to  cold,  moisture,  or  great  fatigue,  although  residing 
in  a  part  of  New  England  where  intermittents  were  never  known 
to  prevail.2 

In  all  fenny  countries,  individuals  exposed  to  the  miasmata  of 
autumn  are  often  affected  for  the  first  time  the  following  winter  or 
spring;  while  exposure,  at  the  latter  seasons,  in  the  same  locality, 
is  in  no  way  attended  with  danger  to  those  who  have  not  imbibed 
the  malaria.  So  frequently  is  this  result  obtained,  that  it  is  very 
generally  admitted  by  the  most  accurate  and  cautious  observers, 
that  vernal  or  winter  periodic  fevers  are  the  offspring  of  autumnal 
exposures.  For  the  occurrence  of  such  cases  in  this  country,  we 
may,  as  Dr.  Drake  has  done,  refer  to  the  experience  of  every  phy 
sician  who  resides  in  regions  infested  with  autumnal  fever.3 

This  power  of  prolonged  latency  is  an  attribute  of  diseases  arising 
from  the  agency  of  morbid  and  specific,  and  of  many  common  poi 
sons — whether  they  are  endowed  or  not  with  contagious  pro 
perties — and  its  manifestation  by  autumnal  fevers,  establishes  the 
fact  of  a  close  connection  between  malaria  and  the  other  class  of 
morbid  agencies  alluded  to,  and  indicates  the  propriety  of  referring 
that  fever  to  a  cause  of  kindred  nature.  According  to  Ilildenbrand, 
the  incubative  period  in  typhus  varies  from  three  to  seven  days 
(p.  30).  Haygarth4  says,  that  of  72  persons  exposed  to  the  poison, 
5  were  attacked  within  ten  days ;  13  between  the  tenth  and  seven 
teenth  day ;  41  between  the  seventeenth  and  thirty-second ;  and  1 
on  the  seventy-second.  Of  typhoid  fever,  we  find  that  the  period 
of  latency,  though  usually  short,  is  sometimes  as  long  as  it  is  in 
typhus,  if  not  longer.  Boudin  states  that  at  Algiers  and  Bone, 

1  Proceedings  of  the  Ala.  Mecl.  Assoc.  for  1852,  p.  115. 

2  Copland's  Diet.  ii.  1000,  note. 

3  Topog.  &c.  of  the  Miss.  Valley,  i.  813;   Cooke,  Med.  Recorder,  vii.  459;   Edinb. 
J.  Ixxi.  355;  Stevenson  the  Blood,  241. 

4  Letter  to  Dr.  Percival,  68. 


AUTUMNAL   FEVERS.  385 

« 
where  this  form  of  fever  does   not  prevail  or  originate,  troops 

arriving  from  Marseilles  suffered  from  it  for  a  few  months,  while 
others  that  arrived  from  elsewhere,  or  had  been  in  the  country 
some  time,  were  exempt.1  Dr.  Williams  states  that  the  period  may 
extend  to  five  or  six  months.2 

None  of  our  readers  need  be  told  that  some  mineral  poisons — as 
arsenic,  mercury,  and  lead,  for  example — occasionally  do  not  manifest 
their  baneful  or  remedial  effects  until  a  long  while  after  being  ab 
sorbed;  and  may  give,  during  a  still  longer  period,  proofs  of  their 
existence  in  the  system,  without,  however,  producing  actual  disease, 
or  even  indisposition.  Orfila  found,  on  the  3d  and  7th  of  February, 
arsenic  in  the  blood  drawn  from  the  arm  of  an  individual  who  had 
swallowed  a  quantity  of  the  metal  on  January  28th.  In'  another 
case,  he  found  the  same  substance  in  the  blood  twenty- two  days 
after  it  had  been  taken.3  The  pestilential  pustule  (bouton  cFAlep) 
does  not  break  out,  in  some  cases,  until  months  after  exposure. 
Boudin  mentions  a  case  in  which  it  made  its  appearance  in  France 
ten  months  after  the  return  of  the  individual  from  the  East.4  Au- 
bert  Eoche  states  that,  during  a  period  of  one  hundred  and  twenty- 
two  years  (1717-1841),  the  incubation  in  plague  was  not  found  to 
be  prolonged  beyond  eight  days.5 

The  researches  of  the  commission  appointed  by  the  Academy  of 
Medicine  of  Paris,  to  investigate  the  subject  of  quarantine,  lead  to 
the  conclusion  that  the  incubation  of  the  plague  varies  according 
to  the  period  of  the  epidemic  and  other  less  influential  circum 
stances.  In  the  early  period  of  an  epidemic,  the  incubation  is  short. 
In  the  second  period,  and  subsequently,  its  duration  varies  from 
three  to  five  days.  The  larger  number  of  the  authorities  consulted 
were  of  opinion  that  the  incubative  process  did  not  exceed  eight 
days ;  some  thought  it  might  run  to  the  tenth  day,  or  even  beyond. 
Such  cases,  however,  appear  to  have  been  rare.  Nevertheless,6 
Pariset  mentions  a  case  in  which  the  period  extended  to  the  thir 
tieth  day.7 

The  usual  length  of  the  period  of  latency  in  hydrophobia  is  esti 
mated  at  between  thirty  and  forty  days.  Mr.  Demeunynk,  in  a 

1  An.  d'Hyg.  xxxiii.  63;  Geog.  Med.  50.  2  Morbid  Poisons,  i.  40. 

3  Bulletin  de  1'Acad.  de  Med.  iii.  598,  G76.  4  Geog.  MeU  65. 

5  De  la  Peste  ou  Typhus  D'Orient,  85. 

6  Rapport  a  1' Academic,  &c.  190,  197;  Clot-Bey,  19. 

7  Revue  Medicale,  Sept.  1844. 

25 


386  PNEUMONIA    AND 

memoir  presented  to  the  Academy  of  Medicine,  in  May,  1839, 
relates  three  cases.  In  one,  the  period  of  incubation  extended  to 
thirty -two  days ;  in  the  second,  it  reached  to  fifty -four  days ;  and  in 
the  third,  the  disease  did  not  break  out  before  three  months.1 
Fothergill2  mentions  the  case  of  a  Mr.  Bellamy,  who  was  bitten  by 
a  rabid  cat,  and  was  attacked  with  that  disease  four  months  after. 
Similar  cases  are  mentioned  by  Mosely  and  Dr.  Matthei  of  Geneva ; 
Yaughan  extends  the  period  to  seven  months;  Fracastorius  to 
eight;3  Mead  to  eleven;4  Bauhin  to  twenty-two;  Dr.  John  Hunter,5 
R.  Hamilton,  and  Nurse,  to  from  seventeen  to  nineteen ;  Grant  to 
twenty;8  while  Lentilius  speaks  of  three  years;  M.  Bouillod  of 
seven  years  ;7  Dr.  Bardsley  of  twelve  years ;  and  Morgagni  of  twenty, 
and  even'  forty.  Leaving  out  the  latter  very  extraordinary  cases, 
for  the  correctness  of  which  I  am  not  prepared  to  vouch,  and  which 
may  have  been,  and  probably  were,  the  effect  of  the  imagination,  or 
symptomatic  of  some  other  complaint,  there  is  enough  left  to  show 
that  the  period  of  latency  in  hydrophobia  is  occasionally  very  long. 
The  length  of  the  period  in  cowpox  varies  from  three  days  to  three 
weeks.  In  a  case  observed  by  M.  De  Lens,  the  disease  did  not 
show  itself  before  a  full  month.8  In  another,  mentioned  by  Dr. 
Stevens,  the  pustule  did  not  make  its  appearance  until  six  weeks 
after  vaccination.9 

The  usual  period  in  chancre  is  from  four  to  eight  days,  unless 
the  surface  is  abraded.  Hunter  has  known  the  disease  to  be  re 
tarded  as  late  as  seven  weeks.  Secondary  syphilis  breaks  out 
ordinarily  between  six  weeks  and  six  months  after  the  cure  of  the 
primary  symptoms ;  sometimes,  however,  not  before  several  years. 
In  one  case,  mentioned  by  Williams,  the  disease  did  not  show  itself 
in  fifteen  years.  The  average  incubative  period  in  smallpox  is 
estimated  at  fourteen  days,  from  exposure  to  the  contagion,  to  the 
appearance  of  the  eruption — the  extremes  being  one  and  three 
weeks — five  to  twenty-three  days,  according  to  Williams.  In  the 
greater  number  of  cases,  no  uneasiness  is  experienced  before  the 
eleventh  or  twelfth  day  after  exposure.  The  period  in  scarlatina 

1  lleport  by  M.  Dubois,  Bulletin  dc  1'  Acad.  iii.  929.  2  Works,  ii.  222. 

3  DC  Contng.  123.  <  The  Med.  Works,  57. 

5  Cyclop,  ii.  492. 

e  Med.  and-Phy.  Tr.  of  Calcutta,  ii.  51. 

7  Anglada,  Traite  de  la  Contagion,  i.  209. 

8  Bousquet,  Traite"  de  la  Vaccine,  525.  9  On  the  Blood,  237. 


AUTUMNAL   FEVERS.  387 

0 

is  from  a  few  hours  to  ten  days.     In  measles,  from  ten  to  sixteen 
days.1 

Process  of  latency  governed  by  definite  laics. — The  results  of  observa 
tions  made  during  a  period  of  a  third  of  a  century,  have  inclined 
me  to  the  opinion,  which  others  had  adopted  long  before,  that  the 
process  of  latency  in  autumnal  fevers  is  ordinarily  governed,  as 
regards  duration,  by  certain  definite  laws,  analogous  to  those  which 
preside  over  the  progress,  fluctuations,  and  return  of  the  same  arid 
some  other  diseases.  The  late  Dr.  R.  Jackson  was  of  opinion  that 
the  aptitude  to  receive  the  morbific  impression  of  the  cause  of  fever, 
takes  place  more  at  particular  periods  than  others ;  that  it  manifests 
itself  more  frequently  about  the  fourteenth  day  after  communication 
with  an  infected  source,  and  that  it  is  observed  chiefly  at  septenary 
periods,  the  seventh,  fourteenth,  twenty-first,  &c.  from  the  time  of 
exposure.  This  opinion  was  based  upon  the  results  of  his  own  ob 
servations,  "  made  upon  numerous  bodies  of  men ;  upon  healthy  men 
placed  as  attendants  in  infected  hospitals,  and  upon  healthy  soldiers 
sent  to  concentrated  sources  of  endemic  fevers."  Among  such,  fever 
scarcely  ever  appeared  before  the  seventh  day,  commonly  not  be 
fore  the  fourteenth,  and  in  numerous  instances  not  till  the  expira 
tion  of  six  weeks,  or  even  two  months ;  though  the  cause  of  disease 
during  the  time  was  ordinarily  in  great  activity.2  Nor  has  it  failed 
to  be  noticed  that  intermittent  fevers  exhibit,  during  their  course, 
a  tendency  to  a  septenary  revolution ;  that  at  those  periods,  either 
after  the  seventh,  fourteenth,  or  twenty-first  paroxysm,  the  disease 
has  a  disposition  to  terminate  spontaneously.  This  was  frequently 
verified  in  Florida,  under  Dr.  Forry's  observations,3  and  has  been 
noticed  sufficiently  often  elsewhere  to  justify  its  being  viewed  in 
the  light  of  a  well-established  fact.  In  remittent  fever,  the  same 
tendency  is  noticed,  the  disease  having  a  particular  disposition  to  a 
favourable  critical  change  on  the  seventh,  fourteenth,  twenty-first, 
and  twenty-eighth  day.4  Nay,  more,  there  are  not  wanting  facts  to 
show  that  the  tendency  to  relapse  in  autumnal  fevers  is  governed 
by  analogous  laws.  We  know  that  in  the  form  of  fever,  which, 
from  its  constant  return  at  stated  times,  after  apparent  convales 
cence,  has  received  the  name  of  the  relapsing  fever,  the  symptoms,. 

1  Williams  on  Morbid  Poisons,  i.  40,  120,  172,  214. 

2  Outlines,  247,  248.  3  Climate  of  the  United  States,  283. 
4  Jackson,  Sketch,  i.  107;  Copland,  ii.  1101. 


388  PNEUMONIA    AND 

after  the  critical  sweat  of  the  fifth  or  seventh  day,  generally  return 
on  the  fourteenth;  and  those  relapses  recur  not  only  once,  but 
several  times.  Other  fevers,  in  like  manner,  show  a  disposition  to 
recur  at  stated  periods.  In  the  government  of  Ufa  (Russia), 
autumnal  fever,  which  in  that  section  of  country  is  very  common, 
attacks  the  patient  every  seventh  day  only,  and  is  so  severe  that  it 
generally  proves  fatal.1  Similarly  to  what  occurs  in  relation  to  the 
decline  of  the  disease,  or  to  its  attack  after  exposure  to  the  cause, 
the  periods  most  remarkable,  according  to  the  ample  experience  of 
Dr.  E.  Jackson,  for  the  recurrence  of  the  symptoms  are  the  sep 
tenary;  the  seventh,  fourteenth,  twenty-first,  and  twenty-eighth, 
with,  as  that  high  authority  adds,  new  and  full  moon.2  Whether 
the  doctrine  will  bear  the  test  of  observation,  particularly  in  its 
application  to  the  period  of  latency,  time  must  determine.  Suf 
ficient  is  it  for  our  present  purpose  to  call  attention  to  the  fact, 
that,  should  the  statement  of  Dr.  Jackson  and  others,  relative  to  the 
period  of  attack  after  exposure,  be  well  founded,  it  furnishes  an 
illustration  of  the  connection  between  the  period  of  latency  and  the 
septenary  revolutions  of  the  system,  so  far,  at  least,  as  the  number 
of  those  revolutions  have  been  counted.  To  this  I  must  add,  that 
individuals  who  relapse  with  fevers,  do  so,  in  all  probability,  in 
consequence  of  the  cause  not  being  completely  eliminated  from 
their  system,  and  remaining  in  a  latent  state  during  the  period  of 
exemption.  If  this  be  admitted,  and  we  find  that  these  relapses 
take  place  at  regular  septenary  periods,  we  derive  from  that  fact  a 
proof  that  the  process  of  latency  is  under  the  influence  of  the  law 
of  septenary  revolution. 

Much  may  be  said  concerning  the  above  law  relative  to  the  period 
of  seven  days  in  fevers ;  for  it  is  one  which,  as  Dr.  Laycock  has 
forcibly  shown,  is  of  very  general  application  in  the  explanation  of 
vital  phenomena  in  health  and  disease.  Everything,  indeed,  leads 
to  the  conclusion  that  a  period  of  seven  days,  and  definite  fractions 
or  multiples  of  that  period,  are  very  prominent  in  the  series  of 
phenomena  called  critical  days,  and  the  operations  of  the  system 
generally.  It  forms  part  of  the  great  fact  of  vital  periodicity,  to 
which  attention  was  called  by  some  of  the  most  ancient  writers  who 
have  left  records  of  their  observations.  The  doctrine  of  septenaries 

1  Notices  of  Russia,  United  Service  Journal,  Jan.  1833,  p.  49. 

2  Sketch,  ii.  212;  Outline,  304. 


AUTUMNAL   FEVERS.  389 

is  literally  as  old  as  the  hills.  Originating  probably  with  the  Chal 
deans  or  Egyptians,  it  formed  part  of  the  system  of  Pythagoras ; 
and  its  application,  to  the  phenomena  of  disease  particularly,  is  dis 
cussed  by  Hippocrates,  Diocles,  Galen,  Celsus,  and  others.  In  his 
ingenious  speculations  on  the  periodicity  of  the  phenomena  of  life, 
Dr.  Laycock  has  shown  that  the  critical  days  of  health  and  the 
critical  days  of  fevers  produced  by  the  entrance  of  a  poison  into 
the  system — whether  that  poison  consist  in  malaria,  or  in  a  conta 
gious  matter — are  identical ;  that  the  depression  of  the  system  will, 
in  consequence,  take  place  at  those  critical  days,  and  that  a  fever 
depending  on  a  poison  is  more  likely  to  appear  on  those  days  than 
on  any  other.  In  confirmation  of  this,  he  states  that  the  latent 
period  in  most  diseases  is  regulated  by  weeks,  as  are  also  the  latent 
period  of  animal  poisons.  He  remarks  that,  in  accordance  with 
this  law,  the  latent  period  of  fever  rarely  extends  beyond  twenty- 
eight  days.  "  If  we  take  menstruation  as  a  type  of  the  critical  days, 
and  suppose  that  a  movement  takes  place  every  seven  days,  gra 
dually  becoming  more  intense  at  each  up  to  the  fourth  week,  we 
have  fever  days,  at  least  in  every  month  in  which  the  peculiar 
symptoms  of  the  poison,  whether  malarious,  exanthematous,  or  con 
tagious,  may  exhibit  themselves;  probably  the  number  may  be 
greater ;  but  if  one  or  two  of  these  days  be  passed  over  without  an 
outburst  of  febrile  action,  it  is  scarcely  possible  that  the  third  or 
fourth  will.1'1 

In  the  fevers  of  hot  climates,  which  are  all  or  for  the  most  part 
malarial,  the  doctrine  of  critical  days,  such  as  it  has  been  transmit 
ted  down  to  us  from  the  days  of  Hippocrates,  has  been  amply  veri 
fied.  On  this  subject,  we  have  the  testimony  of  high  professional 
authorities.2  In  the  fevers  of  Europe,  it  has  been  found  equally 
applicable;3  and  in  this  country,  when  the  efforts  of  nature  are 
not  too  much  interfered  with  by  an  heroic  perturbative  treatment, 
the  Hippocratic  doctrine  often  shines  out  in  all  its  purity.  To  this 
fact,  which  some  twenty  or  thirty  years  ago  it  would  have  been 
considered  heresy  to  allude  to  approvingly,  the  eyes  of  our  more 

1  London  Lancet,  Oct.  1842,  p.  161. 

2  Poisonriier  Fievre  de  St.  Domingo,  119;   Desportes,  Mai.  de  St.  Domingue,  i.  198, 
232;  Dazille,  Maladies  des  Negres,  36,  65;  Bajon,   Mem.  sur  Cayenne,  i.  2d  Mem. ; 
Leblond,  Fievre  Jaune,  43 ;   Levacber,  Guide  Med.  50. 

3  Hildenbrandt,   Med.  Pract.  pt.  i.  chap.  v. ;   De  Haen,  Pract.  Med.  pt.  i.  cap.  iv. ; 
Baglivi,  Opera,  80. 


390  PNEUMONIA    AND 

enlightened  physicians  are  opening.  Even  in  sections  of  country 
where  formerly  the  idea  of  critical  days  met  with  most  opposition, 
a  very  different  sentiment  is  now  found  to  prevail  in  the  minds  of 
correct,  careful,  and  enlightened  observers.  Let  one  example  suf 
fice.  Dr.  Anderson  of  Alabama,  in  a  prize  essay,  already  cited, 
after  remarking  that  a  second  exacerbation  takes  place  the  next 
day  after  an  attack  of  fever,  generally  after  meridian,  adds :  "  This, 
in  turn,  gives  way  during  the  night,  or  towards  morning,  and  an 
other  remission,  more  or  less  decided,  is  observed.  If  the  fever 
take  the  double  tertian  type,  the  next  exacerbation  will  come  on 
during  the  morning,  and  will  be  followed  by  another  the  succeeding 
evening.  The  fever  thus  continues,  sometimes  rising  during  the 
same  hour  every  day,  and  sometimes  later  on  alternate  days,  until 
the  sixth,  when,  if  the  observations  of  the  writer  of  this  essay  are 
worth  anything,  the  fever  (if  it  terminate  favourably)  has  a  decided 
spontaneous  tendency  to  decline,  and  leaves  the  patient  free  .from 
disease  on  the  seventh  day."  Again :  "  The  fever  (malarial)  is  gene 
rally  at  its  height  on  the  fifth  day;  and,  in  bad  cases,  this  is  the 
day  of  danger.  In  malignant  tertian  intermittents,  the  fifth  is  the 
day  for  the  third,  paroxysm,  universally  known  to  be  the  most 
hazardous;  and,  when  death  occurs  in  the  disease,  it  commonly 
takes  place  either  on  that  day  or  during  the  next."  "  Commencing 
practice,"  continues  Dr.  Anderson — whose  fate,  in  that  respect,  has 
been  similar  to  that  of  hundreds  of  physicians  of  this  country — 
"with  an  utter  disbelief  in  the  doctrine  of  critical  days,  the  contrary 
opinion  has  been  forced  upon  me  by  actual  observation.  I  am 
aware  that  the  idea  is  discarded  by  a  majority  of  physicians  of  the 
day;  but  I  think  that  if  any  practitioner  in  the  southwest  will 
carefully  note  down  the  days  in  which  malarious  fever  makes  its 
appearance,  and  record  accurately  its  subsequent  course,  he  will 
find  that  the  doctrine  has  a  foundation  in  fact,  and  is  worthy  of 
some  consideration.  It  is  true,  that  the  fever  may  often  be  made 
much  lighter,  or  apparently  arrested  by  the  administration  of  qui- 
nia  during  the  remissions ;  but  it  will  generally  be  observed  that 
the  patient  does  not  frankly  recover,  and  that  it  is  not  until  the 
seventh  day  that  he  seems  actually  well,  and  clear  of  all  symptoms 
of  the  disease."1 

But  it  is  not  necessary  to  enlarge  farther  on  these  topics.    Enough 

1  Proceedings  of  the  Med.  Assoc.  of  Alabama  for  1852,  p.  107. 


AUTUMNAL   FEVERS.  391 

has  been  said  to  prove  to  the  most  fastidious  inquirer  that,  in 
periodic  fevers,  the  period  of  latency  is  occasionally  remarkably 
long ;  that  in  these  diseases,  as  in  others  appertaining  to  the  class 
of  zymotics,  the  incubative  process,  the  occurrence  of  relapses,  the 
duration  of  the  attack,  and  the  period  of  critical  changes  are  under 
the  control  of  certain  definite  laws.  May  it  not  be  asked  whether 
anything  of  the  kind  has  been  observed  in  regard  to  pneumonia 
and  kindred  inflammations  ?  A  prolonged  incubation  in  such  dis 
eases  may,  for  what  I  know,  have  been  noticed  elsewhere ;  but  so 
far  as  the  experience  of  the  physicians  of  this  section  of  the  country 
extends,  it  may  be  safely  averred  that  nothing  of  the  sort  has 
occurred,  and  I  tax  my  memory  in  vain  for  a  reference,  bearing  on 
this  point,  to  some  one  of  the  many  publications,  foreign  and  native, 
that  have  passed  through  my  hands.  Never  and  nowhere  have  I 
seen,  or  heard,  or  read  of  a  case  in  which  the  attack  has  come  on, 
whether  abruptly  or  preceded  by  premonitory  symptoms,  more 
than  a  few  days  after  exposure  to  the  cause.  An  incubation  of 
eighteen  months  or  a  year,  of  a  month,  or  of  a  fortnight,  has  never 
been,  and  probably  never  will,  nor  can  be  seen  or  heard  of  in  such 
complaints.  Neither  can  we  find  that  the  process  of  incubation  or 
latency  is  under  the  controlling  influence  of  any  fixed  law,  and  has 
a  fixed  and  regular  duration.  The  same  may  be  said  of  relapses 
which  may  occur  at  any  period  during  convalescence,  whether  on 
an  odd  or  even  day.  Such,  at  least,  may  be  presumed  to  be  the 
case,  for  so  far  nothing  satisfactory  has  been  adduced  to  prove  that 
the  phlegmasise  are,  in  regard  to  relapses,  governed  by  the  law  of 
septenaries.  How  far  the  action  of  the  same  law  extends  relatively  to 
the  duration  and  periods  of  critical  changes  in  those  diseases,  remains 
yet  a  mooted  point.  That  the  influence  is  exercised  to  a  certain 
extent,  may  possibly  be  one  day  conclusively  shown ;  for  in  some 
diseases  other  than  those  produced  by  malarial  or  contagious  poi 
sons — hemorrhages  and  nervous  complaints — the  intervals  are  often 
regulated  by  weeks ;  and  in  sundry  acute  and  even  chronic  diseases, 
we  not  ^infrequently  observe — especially  in  the  first,  as  Dr.  Laycock 
well  remarks — a  movement  of  a  tertian  or  quartan  type,  or  in  clini 
cal  phraseology,  a  good  and  a  bad  day. 

In  pneumonia,  as  in  other  affections  attended  with  febrile  reac 
tion,  the  same  tendency  to  a  movement  of  the  kind  is  often  mani 
fested,  and  the  disease  is  found  in  many  cases  to  end  on  particular 
days.  But,  so  far  as  observations  go,  the  exhibition  of  a  tertian  or 


392  PNEUMONIA    AND 

quartan  movement,  is  not  as  generally  noticed  in  such  complaints 
as  in  the  pyrexiae,  while  the  disease  is  far  less  under  the  control, 
in  regard  to  the  period  of  critical  changes  and  to  duration,  of  the 
law  so  often  referred  to.  If  exceptions  are  encountered ;  if  cases 
of  this  and  other  kindred  diseases  are  found,  in  which  the  critical 
movements  referred  to  are  as  marked  and  regular  as  they  are  in 
autumnal  fevers  generally,  it  is  principally  among  those  on  which 
the  malarial  poison  has  produced  its  impress,  or  which  are  com 
bined  with  a  malarial  complaint.  For  this  poison,  while  engrafting 
the  periodic  type  on  the  diseases  with  which  it  combines,  imparts 
to  them  many  of  the  other  peculiarities  which  characterize  its  legi 
timate  offspring.  True  it  is,  that  Dr.  Traube  has,  in  his  experi 
ments,  found  that  in  many  cases  of  pneumonia  the  period  of 
termination  was  marked  by  some  critical  discharge;  and  that  in 
many  the  change  began  to  take  place — when  the  disease  ended 
within  the  first  fortnight — either  on  the  third,  the  fifth,  seventh, 
ninth,  or  eleventh  day.  Out  of  fifty-two  cases  of  disease  analyzed, 
the  change  suddenly  took  place  in  thirty.  Out  of  twenty-seven  of 
these,  four  ended  on  the  third ;  nine  on  the  fifth ;  eleven  on  the 
seventh ;  two  on  the  ninth ;  and  one  on  the  eleventh  day.  In  two 
of  the  remaining  cases,  the  beginning  of  the  disease  could  not  be 
accurately  fixed,  and  in  one  the  change  took  place  on  the  seven 
teenth  day.  Dr.  Traube's  reviewer,  Dr.  Herman  Weber,  remarks : 
"  Amongst  sixty-two  acute  cases,  into  which  we  lately  accurately 
inquired  with  this  purpose,  in  eighteen  only  could  we  ascertain  the 
commencement  of  the  disease;  in  five  of  these  cases  the  notes  on  the 
temperature  are  not  sufficient  to  be  analyzed  for  the  present  sub 
ject  ;  of  the  remaining  twelve,  the  change  took  place  rapidly  in 
eight  cases,  and  of  these,  on  the  fifth  day,  in  two  cases ;  between 
the  fifth  and  sixth  day,  in  one  case ;  on  the  seventh  day,  in  two 
cases ;  between  the  seventh  and  eighth,  in  one  case ;  on  the  ninth 
day,  in  one  case ;  between  the  ninth  and  the  tenth,  in  one  case."1 
But  the  number  of  cases  in  which  the  observation  held  good  is, 
after  all,  but  small ;  and  of  those  in  which  it  was  verified,  we  are 
not  positively  informed  how  many  were  of  pneumonia,  and  whe 
ther  the  disease  was  pure  or  complicated ;  and  as  we  find  that 
many  of  the  individuals  experimented  upon  were  affected  with 
typhoid  fever,  and  as  this,  like  other  zymotic  diseases,  may  reason- 

1  See  Brit,  and  For.  Med.-Chir.  Rev.  xi.  44,  45. 


AUTUMNAL   FEVERS.  393 

ably  be  supposed  to  be  governed  by  different  laws  from  common 
inflammation,  we  can  derive  no  accurate  information  relative  to  the 
subject  before  us,  so  far  as  it  applies  to  pneumonia,  from  the  state 
ments,  interesting  as  they -doubtless  are,  of  those  writers.  Besides, 
if,  in  some  cases  of  this  disease,  the  influence  of  the  law  is  found  to 
be  felt ;  in  a  greater  number  of  others,  not  less  accurately  observed, 
it  has  failed  to  be  so. 

Andral  remarks  that  pneumonia  is  one  of  those  diseases  in  which 
the  question  seems  the  most  easy  to  decide ;  because,  on  the  one 
hand,  the  precise  period  of  its  onset  is  often  very  well  marked ; 
while,  on  the  other,  the  period  of  its  termination  is  often  just  as 
easily  ascertained.  One  hundred  cases  gave  the  following  results 
in  the  hands  of  this  accurate  observer  :— 

3  ended  on  the 4th  day. 

2       "  5th     " 

6  "         " 6th     " 

23       "  7th     " 

2  "                     8th  " 

4  "          " 9th  " 

11  "          " 10th  " 

13  "" llth  " 

1  «          « 12th     " 

2  "  13th     " 

11  "          " 14th     « 

2       "          "  ...'..     loth     " 

2  "  " 16th  " 

9  "  " 20th  " 

1  "  "  .....  27th  " 

1  "  « 42d  " 

Of  the  remainder,  the  period  of  termination  could  not  be  ascer 
tained  precisely. 

3  lasted  from  .         .         .  5  to    7  days. 

12  "        "  .        .        .        .      7  to  14     " 

7  "        "  .        .        .        .     14  to  20     " 

4  "  ....     20  to  30     " 

From  this  it  follows  that  the  days  on  which  the  larger  number 
terminated,  were  the  seventh,  eleventh,  fourteenth,  and  twentieth.1 

1  Clinique  Medicale,  i.  558,  559. 


394:  PNEUMONIA    AND 

To  a  certain  extent  the  result  is  favourable  to  the  Hippocratic  doc 
trine,  though  it  must  be  borne  in  mind  that  the  number  of  cases 
which  ended  on  those  days  did  not  amount  to  more  than  one-half 
of  the  whole.  On  the  other  hand,  the  results  obtained  by  Grisolle, 
are  far  from  corroborating  any  conclusion  favourable  to  the  afore 
said  doctrine  that  might  be  drawn  from  the  facts  heretofore 
adduced.  This  author  studied  all  the  phenomena  of  the  disease, 
from  the  beginning  to  the  end,  in  one  hundred  and  thirty  cases. 
In  thirty -four  of  these,  or  about  one-third,  the  period  of  the  resolu 
tion  coincided  with  some  of  the  phenomena  usually  regarded  as 
critical.  In  twenty-two,  there  was  sweat,  with  or  without  deposit 
in  the  urine,  either  spontaneous  or  artificially  obtained  by  nitric 
acid.  In  six,  the  disease  ended  by  eruptions  on  the  lips ;  in  four, 
by  urine ;  in  two,  by  hemorrhage.  To  a  certain  extent  the  absence 
of  critical  movements  in  those  cases  may  have  been  due  to  the  kind 
of  treatment  pursued ;  and  to  the  same  circumstance  may  be  ascribed 
the  fact  that  these  movements  are  less  trenchant,  or  easily  made 
out  at  present,  than  they  probably  were  in  Greece  at  the  time  of 
Hippocrates,  whose  treatment,  as  Baglivi1  remarked  long  ago,  was 
purely  expectant,  and  did  not  disturb  or  oppose  the  efforts  of  nature. 
But  to  this  cause  alone  we  shall  not  feel  disposed  to  ascribe  the 
whole  of  the  difference,  if  we  bear  in  mind  that,  though  more  active 
now  than  it  was  in  ancient  times,  the  treatment,  in  the  hands  of 
judicious  and  skilful  physicians,  has  for  its  main  object  the  aiding 
nature,  and  that,  if  those  critical  movements  were  in  pneumonia,  as 
in  fevers,  the  governing  power,  they  would  be  promoted  instead  of 
impeded  by  the  means  employed.  To  this,  let  it  be  added  that,  in 
regions  of  country  similar  to  Greece  in  respect  to  climate,  cases  of 
pneumonia  in  which  the  phenomena  in  question  are  well  marked, 
the  effect  has  usually  been  found  to  be  the  result  of  a  complication 
with  a  malarial  disease. 

As  to  the  period  at  which  those  critical  phenomena  manifested 
themselves,  one  of  the  cases  observed  by  Grisolle  ended  on  the 
fourth  day;  seven  on  the  fifth;  four  on  the  sixth;  three  on  the 
seventh ;  two  on  the  eighth ;  eleven  on  the  ninth ;  one  on  the  tenth ; 
and  three  on  the  thirtieth.  Few,  as  will  be  perceived,  presented 
salutary  discharges  on  what  Hippocrates  regarded  as  the  essentially 
critical  days,  the  seventh,  fourteenth,  and  twentieth.  So  far  from 

1  Opera  Omnia,  80. 


AUTUMNAL   FEVERS.  395 

it,  the  greater  number  of  critical  discharges  (twenty)  presented 
themselves  on  those  days  when  the  crises  were  considered  by  him 
as  occurring  less  frequently,  and  as  being  less  effectual.  In  eight, 
the  change  took  place  on  empty  days,  i.  e.  those  which  were  not  con 
sidered  as  periods  of  crisis ;  and  four  presented  critical  movements 
on  the  sixth  day,  which,  by  the  Hippocratic  school,  was  viewed  as 
the  most  pernicious,  and  hence  was  denominated,  by  Galen,  the 
tyrant.  From  all  this,  Dr.  Grisolle  very  justly  infers  that  the  doc 
trine  of  critical  days  is  very  unsettled,  "  and  that  it  cannot  be  re 
garded  as  founded,  so  far  as  relates  to  pneumonia."1  If,  in  addition 
to  all  this,  we  inquire  as  to  the  results  observed  in  ten  cases  in 
which  the  disease  was  left  to  the  powers  of  nature,  we  find  that,  in 
more  than  one-half  of  that  number,  the  crisis  took  place  on  empty 
days ;  convalescence  commenced  in  six  on  those  days,  and  in  four 
only  on  genuine  critical  days ;  a  circumstance  militating  still  more 
strongly  against  the  doctrine  in  its  application  to  the  disease  in 
question. 

In  some  forms  of  autumnal  fever  the  susceptibility  of  the  system  ex 
hausted  by  one  attack — not  so  in  pneumonia. — It  is  a  fact  very  generally 
conceded,  that  one  attack  of  some  forms  of  malarial  fever  exhausts 
the  susceptibility  of  the  system  to  the  subsequent  action  of  the 
poison  giving  rise  to  them.  This  is  more  particularly  the  case  with 
respect  to  the  yellow  fever,  which,  according  to  the  highest  profes 
sional  authorities  in  various  parts  of  tropical  climates,  as  well  as  in 
Europe  and  this  country,  seldom,  if  ever,  attacks  the  same  indi 
vidual  more  than  once.  I  am  aware  that  exceptions  on  this  point 
are  to  be  met  with ;  that  by  some  they  are  represented  as  being 
quite  numerous,  and  that  by  a  different  set  of  authorities  they  are 
maintained  to  be  so  frequently  encountered  as  to  invalidate  or 
annul  any  rule  attempted  to  be  established  on  the  subject.2  But, 
notwithstanding  all  that  has  been  said  in  favour  of  this  opinion,  the 
experience  of  those  competent  to  decide  in  the  matter,  will  justify 
the  conclusion  that  instances  of  the  repetition  of  the  disease  are 
comparatively  rare ;  that  one  attack  of  true  yellow  fever  serves,  if 

1  Trnitc  tie  la  Pneumonic,  324,  325. 

2  R.  Jackson,  Yellow  Fever  of  Spain,  50;   Edinb.  Journ.  Ixviii.  497;   Bancroft's 
Sequel,  42  ;   Rush,  iii.  87,  88 ;   Maclean  on  Epid.  i.  233  ;  Pinkard's  Notes  on  W.  I.  ii. 
257  ;   Tullock's  Stat,  of  Brit.  Army,  4  ;  Labat,  ii.  74,  iv.  307  ;  Arnold,  62  ;  Former,  N. 
0.  Journ.  v.  200. 


396  PNEUMONIA    AND 

not  always,  at  least  in  the  large  majority  of  cases,  as  a  protection 
against  reinfection;  that  when  in  the  "West  Indies,  and  other  sec 
tions  of  hot  latitudes,  second  attacks  present  themselves,  they  most 
usually  do  so  in  individuals  whose  systems,  after  having  passed 
through  the  disease,  have  been  modified  or  renovated  by  a  long 
residence  in  some  cold  region — or  by  spending  much  time  at  sea — 
or  in  whom  the  original  attack  was  mild;  or  again  among  those 
who,  after  having  experienced  an  attack  of  the  fever  in  its  sporadic 
form,  or  during  the  course  of  a  mild  epidemic,  become  exposed  to 
an  extensive  and  malignant  visitation  of  the  same.  Cases  of  the 
kind,  whatever  be  the  circumstances  under  which  they  may  occur, 
are,  I  repeat,  few  in  number,  and  scarcely  more  frequently  encoun 
tered  than  are  second  attacks  of  smallpox,  scarlet  fever,  and  kin 
dred  diseases,  the  protective  power  of  which  is  fully  recognized.1 

It  is  more  than  probable  that  those  who  contend  for  the  frequent 
repetition  of  the  yellow  fever  in  the  same  individual,  will  be  found 
principally  among  the  advocates  of  the  identity  of  that  and  other 
forms  of  autumnal  fevers.  If  this  be  correct,  the  instances  of 
second  attacks  recorded  or  referred  to,  may  reasonably  be  supposed 
to  have  been  cases  not  of  true  yellow  fever,  but  of  ordinary  bilious 
remittent  fever,  and  we  shall  read  with  less  astonishment  of  the 
individual  mentioned  by  Dr.  Potter,  of  Baltimore,  who  had  the 
disease  as  many  as  eight  times.  Dr.  Potter,  as  also  Dr.  Eush,  Dr. 
McLean,  Dr.  Pinkard,  Dr.  R.  Jackson,  Dr.  Bancroft,  and  others  in 
this  country  and  abroad,  who  speak  so  confidently  of  such  frequent 
repetitions  of  the  disease  as  an  every-day  occurrence  in  yellow 

1  Lining,  ii.  490 ;  Dickson,  Phil.  Med.  and  Phys.  Journ.  iii.  273  ;  ib.  Essays,  352  ; 
Irving,  31;  Simons,  21  ;  Francis,  N.  Y.  Journ.  i.  299;  Currie,  15;  Hosack,  i.  385; 
Townsencl,  217;  Archer,  Med.  Ilec.  v.  61;  Kelly,  Am.  Journ.  Oct.  1847;  Barton, 
Hep.  21;  Cartwright,  Rcc.  vii.  15;  Wood,  i.  304;  Arejula,  191;  Fellowes,  xxiii.  67; 
Berthe,  336;  Gilpin,  Med.-Chir.  Tr.  v.  318;  Amiel,  in  Johnson,  on  Tr.  Cl.  269;  Parisct, 
97  ;  Wilson,  73,  74 ;  Pym,  29  ;  Appendix,  302 ;  Rochoux,  38 ;  Pugnet,  348,  349 ;  Chis- 
holm,  ii.  233;  Savaresi,  256;  II.  McLean,  8,  187;  Caillot,  249;  Gilbert,  76;  Pariste, 
38,  112;  J.  Clark,  19;  Blanc,  ii.  147,  148;  Forry,  205;  Williamson,  i.  311;  Strobell, 
202;  Dickinson,  40,  47,  68;  Doughty,  183;  Copland,  Diet.  ii.  951  ;  Mitchell,  128 ; 
Chapman,  Phil.  Med.  and  Phys.  Journ.  ix.  130;  Seamen,  Med.  Repos.  i.  319;  ib. 
Fever  of  1795,  in  Webster's  Coll.  40;  Blair,  85,  86;  Hume,  241 ;  Klapp,  Med.  Rep.  vi. 
472;  Veitch,  110;  Monges,  N.  A.  Journ.  ii.  58;  Ashbel  Smith,  Trans,  of  N.  Y.  Acad. 
of  Med.  i.  59;  Treat,  on  Yellow  Fever  of  Galvcston,  60;  Davy,  Notes  on  Blair,  85; 
Lewis,  Fever  of  Mobile,  N.  0.  Journ.  i.  418,  ii.  43,  iv.  162;  McCrnven,  Top.  and  Dis. 
of  Houston,  Texas,  Trans,  of  Am.  Mod.  Assoc.  v.  669 ;  Jameson,  Dublin  Journ.  of 
Med.  Sci.  (N.  S.)  xvi.  358. 


AUTUMNAL   FEVERS.  397 

fever  regions,  are  all  firm  believers  in  the  identity  in  question ; 
while  we  shall  look  in  vain,  in  the  writings  of  those  who  entertain 
different  pathological  views,  for  the  admission  that  such  cases 
should  be  regarded  otherwise  than  as  exceptional.  But  even  were 
we  to  admit  that  the  disease,  in  all  the  instances  of  repeated  attacks 
mentioned,  whether  the  second  or  the  eighth,  was  really  the  true 
genuine  yellow  fever,  we  should  not  be  justified,  from  that  circum 
stance,  in  denying  the  protective  power  of  the  disease ;  not  only 
because  such  instances  are,  after  all,  comparatively  rare,  but  because 
occurrences  of.  an  analogous  kind  are  encountered  in  diseases  which 
possess  that  power  in  a  marked  degree.  As  already  mentioned, 
second  attacks  of  smallpox,  scarlet  fever,  and  other  kindred  dis 
eases,  are  not  unfrequently  encountered — nay,  it  is  doubtful  whether 
yellow  fever  repeats  itself  more  frequently  than  either ;  and  cases 
are  on  record  in  which  they  have  outdone  in  point  of  repetition, 
anything  that  can  be  related  of  the  yellow  fever.  Dr.  Davy  informs 
us,  on  the  authority  of  a  general  officer  (whose  mother  was  the 
subject),  of  a  case  in  which  the  smallpox  was  repeated  eleven  times 
in  the  same  person.1 

Other  forms  of  malarial  fever  afford,  if  we  may  credit  the  state 
ments  of  respectable  authorities,  protection  against  reinfection.  In 
the  West  Indies,  there  are  several  forms  of  fever  distinct  from  the 
true  typhus  icterodes,  and  which  Dr.  Copland  has  denominated 
bilio-inflammatory  or  ardent  fever,  and  adynamic  marsh  fever, 
which  act  as  seasoning  fevers  to  Europeans  who  arrive  in  hot  cli 
mates  ;  the  former  appearing  in  robust  plethoric  persons,  who  have 
emigrated  to  the  West  Indies,  intertropical  Africa,  &c.,  the  other 
in  those  less  robust,  or  who  have  not  been  attacked  by  ardent  fever.2 
Dr.  Stevens  also  recognizes  the  existence  of  two  fevers  independent 
of  the  true  yellow  fever,  which  he  denominates  African  typhus, 
and,  like  Chisholm,  Pym,  and  some  others,  regards  as  a  native  of 
Africa,  One  of  the  other  two  aforesaid  fevers,  he  designates  the 
climate  fever.  It  corresponds  to  the  bilio-inflammatory  of  Copland, 
and  is  a  seasoning  fever,  and,  as  a  general  rule,  is  not  taken  twice, 
unless  the  individual  so  attacked  has  left  the  West  Indies  and 
returned  again,3  The  Batavian  and  Edam  fever,  which,  notwith 
standing  some  points  of  similitude  with  the  yellow  fever  of  the 
West  Indies,  and  the  occasional  occurrence  in  it  of  a  few  of  the 

1  Notes  on  Blair,  86.  2  Diet.  ii.  1104.  3  On  the  Blood,  194. 


398  PNEUMONIA    AND 

symptoms  appertaining  to  the  latter,  cannot  be  considered  as  iden 
tical  with  it,  is  also  evidently  a  seasoning  fever.1 

The  pernicious  fevers  of  Algeria,  France,  and  other  localities — 
the  periodic  and  malarial  nature  of  which  cannot  be  disputed,  have 
never,  in  the  experience  of  Dr.  Boudin,  attacked  the  same  individual 
a  second  time.2  After  observing  that,  with  one  exception,  the  exan 
themata,  which  occur  only  once,  have  a  quartan  type,  Dr.  Lacock3 
says  that  "  it  is  at  least  a  carious  coincidence,  that  a  person  who  has 
had  a  quartan  ague  is  not  liable  to  a  second  attack."  Sydenham 
many  years  ago  made  the  remark,  and  stated  as  a  fact  worthy  of 
observation,  that  if  any  person  be  seized  with  a  quartan  who  has 
had  it,  though  long  since,  it  terminates  spontaneously  after  a  few 
fits,  of  whatever  age  or  constitution  he  be.4  After  him,  Van 
Swieten,  as  Dr.  Lacock  reminds  us,  expressly  stated  and  insisted 
upon  the  same  feet;  and  Dr.  Wallis,  in  his  note  upon  the  above 
passage  in  Sydenham,  confirms  the  statement,  and  remarks  that  "it 
is  known  from  observation,  in  the  marshes  of  Essex,  the  fens  of 
Cambridgeshire,  and  other  places  where  intermittents  are  ende- 
mial,  that  those  who  have  laboured  once  for  a  scries  of  time  under 
this  complaint,  which  will  sometimes  continue  two  or  three  years 
with  short  intervals,  and  escape  the  fatal  consequences,  will  after 
wards  live  totally  free,  or  subject  only  to  very  slight  attacks,  which 
spontaneously  disappear;  though  this  is  not  ahvays  the  case."5  Sir 
Gilbert  Blane  states  of  the  fever  of  Walcheren,  that  it  is  well  ascer 
tained  that  strangers,  if  they  survive  the  first  attack,  become  there 
after  much  less  liable  to  the  endemic  intermittents.6 

Some  of  the  physicians  whose  views  are  now  under  examination. 
will  not  find  fault  with  me  for  calling  their  attention  to  the  fact 
that  second  attacks  of  typhoid  fever,7  a  disease  which  doubtless 
arises,  in  some  instances  at  least,  from  peculiar  malarial  sources,  or 
at  any  rate  is  most  certainly  localized  where  these  exist,  and  which 
not  a  few  of  them  regard  as  nothing  more  than  a  peculiar  form  of 
autumnal  or  periodic  fever,  are  seldom  encountered.  By  some  of 
them,  too,  Asiatic  cholera  is  held  in  much  the  same  light.  Let 
them  say  how  many  cases  of  second  attacks  they  have  observed  in 
that  disease. 

1  Johnson,  op.  eif.  lol.  2  Geographic  MeMicule,  40. 

3  Lancet,  18-12,  i.  102.  4  Sydenham,  Wallis's  edit.  5.  82. 

5  Ibid.  82.  c  Dissertations,  i.  221. 
"  IJartlett  on  Fevers,  08. 


AUTUMNAL   FEVERS.  399 

Dr.  Barker,  in  liis  report  of  the  Cork  Street  Hospital,  Dublin, 
states  that  he  has  for  some  time  entertained  the  opinion,  that  sufferers 
from  fever,  attended  with  petechial  eruption,  if  they  are  not  alto 
gether  secured  by  it  from  a  second  attack*  are  not,  at  least,  so  liable 
to  it  as  those  who  have  had  no  fever  of  the  ordinary  kind.  And, 
in  continuation,  he  says :  "  Though  I  have  frequently  made  the 
inquiry,  I  have  not  found  a  patient  in  whom  this  symptom  was  dis 
tinct,  who  had  suffered  from  the  same  fever  on  any  former  occasion. 
The  analogy  which  this  bears  to  other  fevers,  more  especially  to 
that  which  appeared  at  Gibraltar,  and  also  to  some  exanthematous 
diseases,  lend  support  to  the  opinion  of  its  rarely  occurriog  more 
than  once  in  life."1 

But  while  the  power  of  exhausting  the  susceptibility  of  the  sys 
tem  to  future  attacks  appertains  to  some  forms  of  autumnal  fevers, 
as  also  to  several  other  diseases,  which  many  of  the  advocates  of  the 
views  under  examination  have  no  hesitation  in  regarding  as  mere 
modified  forms  of  periodic  fevers,  it  would  be  wrong  to  attribute 
the  same  privilege  to  all  the  other  forms  of  these.  Experience,  in 
deed,  teaches,  that  however  true  it  may  be  that  the  severe  and 
malignant  bilious  remittent  of  the  West  Indies  assumes,  at  times, 
the  character  of  a  seasoning  disease,  and  guards  against  the  return 
of  the  same — so  long,  particularly,  as  the  individual  remains  in  the 
country — the  rule  is  far  from  being  general,  and  does  not  apply  to 
the  common  forms  of  the  disease;  for  it  is  a  well-established  fact, 
that  in  temperate  climates  an  attack  of  remittent  or  intermittent 
fever  not  only  fails  to  impart  perfect  immunity  to  the  sufferer,  but 
is  regarded  by  accurate  and  experienced  observers  as  affording  no 
protection  at  all,  and  even  as  increasing  the  liability  of  the  system 
to  fresh  invasions  of  the  complaint.2 

If  now  we  inquire  how  matters  stand,  so  far  as  concerns  pneumo 
nia,  in  reference  to  the  exhausting  power  in  question,  we  shall  find, 
that  while  that  disease,  and  indeed  all  those  of  the  same  class, 
approximate  to  some  forms  only  of  malarial  fevers,  it  differs  widely 
from  several  of  the  more  important  ones ;  for,  like  bilious  remittents 
and  intermittentSj  but  unlike  yellow  and  other  fevers  mentioned, 
one  attack  of  pneumonia,  nowhere  and  under  no  circumstances, 

1  Bracken's  Kept,  in  Barker  and  Cheyne's  Acc't  of  Fey.  of  Ireland,  i.  241. 

2  Asbbel  Smith,  loc.  cit.  58;  Dickson's  Essays,  &c.  344,  345;  do.  Charleston  J.  vii. 
840;  Simons,  21;  Wood,  i.  304;  Tullock,  Statist.  4G  ;  Strobcl,  203;  Parry.  Am.  J., 
Jan.  1843. 


400  PNEUMONIA    AND 

whether  in  the  north  or  the  south,  the  east  or  the  west ;  whether 
the  case  be  mild  or  severe,  simple  or  complicated,  affords  the  most 
remote  shadow  of  protection  against  the  recurrence  of  the  disease. 
So  far  from  its  doing  so,  everywhere  we  find  that  persons  who  have 
laboured  under  pneumonia,  are  by  that  very  fact  rendered  more 
liable  to  the  complaint  than  they  were  prior  to  the  attack.  Hence, 
second  and  third  repetitions  are  very  frequently  observed,  especially 
in  the  same  lung.  The  disease  has  been  noticed  ten  times  in  the 
same  individual  by  Chomel;  eleven  times  by  Frank ;  sixteen  times  in 
eleven  years  by  Andral;  twenty-eight  times  by  Eush;  three,  four, 
five,  seven,  and  eight  times  by  Grisolle  ;*  and  there  is  scarcely  a 
practitioner  in  this  or  any  other  country,  who  has  not  witnessed 
instances  of  the  kind. 

It  is  not  to  be  denied  that,  on  this  particular  point,  pneumonia, 
while  differing  greatly  from  some  of  the  forms  of  autumnal  fevers, 
allies  itself  to  others  which  do  not  possess  the  power  of  exhausting 
the  susceptibility  of  the  system  to  future  attacks;  and  the  advocates 
of  the  close  alliance  and  identity  of  the  two  diseases  may  appeal  to 
this  circumstance  in  proof  of  the  correctness  of  their  views.  But 
on  reflection,  the  reader  will,  unless  I  am  greatly  mistaken,  join  in 
the  opinion  that  the  similarity  in  question  can  afford  but  little  if 
any  support  to  the  idea  of  pneumonia  being  only  a  peculiar  form 
of  autumnal  fevers.  For,  if  an  argument  is  built  upon  the  circum 
stance  that  neither  pneumonia  nor  the  forms  of  malarial  fever  in 
question  afford  protection  against  future  attacks  of  the  same,  what 
shall  we  do  with  the  fact  that  other  forms  of  those  fevers  possess 
the  privilege  in  question  ?  The  latter  fact  is  not  to  be  ignored ;  and 
if  the  advocates  of  the  identity  of  pneumonia  with  periodic  fever 
are  permitted  to  adduce  in  support  of  their  views  the  absence  of  the 
exhausting  power  in  both  the  former,  and  some  of  the  varieties  of 
the  latter,  no  reason  can  be  assigned  for  refusing  to  the  opponents 
of  that  hypothesis  the  liberty  of  pointing  out,  in  proof  of  the  sound 
ness  of  their  theory,  the  existence  of  that  very  power  in  yellow  and 
some  other  fevers,  the  malarial  origin  of  which  is  as  evident  as  that 
of  common  bilious  remittents  and  intermittents.  In  this  way,  we 
should  have  both  parties  in  the  controversy  appealing  to  opposite 
peculiarities  in  different  forms  of  the  same  class  of  diseases,  to  prove 

1  Cyclopedia  of  Pract.  Med.  iii.  406;  Chomel,  Diet,  de  Medecine,  xvii.  214;  Frank, 
Intern.  Cl.  Obs.  Select.  96;  Andral,  Med.  Cl.  192;  Desoteux,  Diet,  des  Sc.  Med.  xliii. 
376;  Grisolle  Tr.  de  la  Pncumome,  111. 


AUTUMNAL    FEVERS.  401 

or  disprove  the  identity  of  these  with  pneumonia.  So  far  from  con 
ceding  to  the  advocates  of  the  unity  in  question,  the  propriety  of 
deriving  an  argument  from  the  similarity  or  absence  of  the  power 
of  exhaustion  alluded  to  in  pneumonia,  and  in  common  periodic 
fevers,  there  can  be  no  difficulty  in  perceiving  that  the  fact  of  the 
poisons  of  yellow,  and  of  some  other  kindred  fevers,  exhausting  the 
susceptibility  of  the  system,  must  lead  to  very  contrary  conclusions, 
and  fortify  us  in  the  belief  of  the  propriety  of  establishing  a  line  of 
separation  between  pneumonia  and  malarial  fevers  generally.  These 
fevers,  as  we  have  seen,  are,  like  other  zymotic  diseases,  the  off 
springs  of  particular  poisonous  agents  introduced  into  the  system, 
and  therein  producing  special  effects ;  and  the  only  difference  be 
tween  them,  so  far  as  regards  the  exhausting  power  in  question, 
depends  on  this,  that  in  some  forms  the  morbid  poison  in  its  action 
on  the  system  destroys  certain  materials  or  principles,  the  existence 
of  which  is  necessary  to  enable  the  latter  to  be  morbidly  affected 
by  the  impress  of  that  poison ;  while,  in  the  other  case,  the  poison 
possesses  no  such  destructive  effects,  and  leaves  the  system  suscep 
tible  of  being  again  affected  by  it. 

While  bearing  this  in  mind,  the  reader  must  not  lose  sight  of  the 
circumstance  that  this  power  of  exhaustion,  though  possessed  by 
many  of  the  morbid  poisons,  is-  not  a  necessary  and  indispensable 
attribute  of  them  all ;  for  among  them  not  a  few  are  found,  which, 
while  affecting  the  system  in  a  specific  manner,  and  occasioning 
diseases  of  a  highly  and  often  fatal  character,  do  not  impart  to 
those  who  recover  the  power  of  resisting  their  future  morbid  im 
press.  In  this  category,  we  may  place  a  number  of  the  animal 
poisons  and  venoms.  The  absence  of  the  same  power  of  exhausting 
the  susceptibility  of  the  system  to  reinfection,  cannot,  therefore,  be 
adduced  in  denial  of  the  toxical  nature  of  the  cause  of  the  particular 
forms  of  autumnal  fever  in  which  it  is  noticed,  and  as  lending  sup 
port  to  the  belief  in  the  close  connection  referred  to  between  such 
fevers  and  pneumonic  inflammations.  If  we  refuse  to  admit  the 
toxical  nature  of  those  fevers  on  the  score  of  the  absence  in  them 
of  the  power  in  question,  and  acquiesce  for  the  same  reason  in  the 
propriety  of  severing  them  from  zymotic  diseases  with  the  view  to 
class  them  with  pneumonia,  we  cannot  object  to  rejecting  from  the 
list  of  morbid  poisons  the  animal  venoms  and  poison  above  alluded 
to,  and  classing  the  diseases  they  produce  among  the  phlegmasias 
of  the  chest.  The  conclusion  in  the  one  case,  would  be  just  as 
26 


402  PNEUMONIA    AND   AUTUMNAL   FEVERS. 

reasonable  as  in  the  other ;  and  I  close  the  subject  with  the  remark 
that,  in  all  malarial  or  autumnal  fevers,  the  introduction  of  a  poi 
son,  whether  endowed  with  that  destructive  agency  or  otherwise 
matters  not,  is  necessary  to  occasion  the  disease — a  circumstance 
very  different  from  what  occurs  in  pneumonia,  the  production  of 
which  is  in  no  way  connected  with  the  existence  of  a  poisonous 
agent ;  and  if  the  latter  disease  assimilates  itself  with  some  forms 
of  malarial  fevers  in  this,  that,  like  them,  it  leaves  the  system  sus 
ceptible  to  farther  attacks,  it  differs  from  them  in  not  being  the 
result  of  a  morbid  poison,  as  well  as  in  its  phenomena,  anatomical 
characters,  and  other  circumstances  already  dwelled  upon ;  while 
those  fevers,  though  not  exhausting  the  susceptibility  of  the  system, 
present  a  close  analogy  to  those  that  possess  the  privilege  of  doing 
so,  in  regard  to  their  toxical  origin,  their  phenomena,  their  anatomi 
cal  characters,  and  the  laws  by  which  they  are  governed.  Viewed, 
therefore,  as  a  class,  malarial  fevers — like  many  other  zymotic  dis 
eases — may  be  considered,  so  far  as  concerns  second  attacks,  as 
differing  from  pneumonia. 


CHAPTER  VI. 

PNEUMONIA  AND  AUTUMNAL  FEVERS  COMPARED  IN  REFER- 
ENCE  TO  THE  POWER  OF  ACCLIMATIZATION — AGES,  SEXES, 
AND  RACES  OF  THOSE  AFFECTED:  PREVALENCE  OF  THE 
TWO  DISEASES  AT  THE  SAME  TIME,  AND  IN  RAPID  SUC 
CESSION,  NO  PROOF  OF  IDENTITY. 

The  power  of  acclimatization  does  not  extend  to  pneumonia — Still 
more  strikingly  do  autumnal  fevers  of  various  forms  and  grades 
differ  from  pneumonia,  on  the  score  of  the  protection  afforded 
against  attacks  of  those  diseases,  by  the  peculiar  organic  changes, 
resulting  from  long  habituation  to  the  sensible  or  insensible  quali 
ties  of  the  atmosphere  of  particular  regions  or  localities,  or  to  the 
poisonous  materials  by  which  that  atmosphere  may  be  contaminated. 
That  such  a  protection  is  thus  obtained,  to  a  greater  or  less  extent, 
in  regard  to  all  malarial  and  some  other  forms  of  fever,  no  one  who 
has  examined  the  subject  with  attention  will  feel  disposed  to  deny. 
By  long  habituation  to  infectious  localities,  and  to  the  high  temper 
ature  of  hot  regions,  the  system  becomes  acclimatized,  and  thereby 
acquires  the  power  of  tolerating  perfectly  and  permanently  the 
poison,  or  of  eliminating  it  as  soon  as  received,  without  succeeding 
reaction.  The  observation  is  of  old  standing.  Pliny,  nearly  twenty 
centuries  ago,  called  attention  to  the  fact,  "  that  they  who  are  sea 
soned  can  live  amid  pestilential  diseases,"  and  the  statement  has 
been  confirmed  by  all  subsequent  observations. 

Equally  well  ascertained  is  it,  that  the  danger  of  infection  among 
strangers  increases  in  proportion  to  the  coldness  of  their  native 
land,  or  of  their  accustomed  place  of  residence  j1  that  protection  in 
its  entire  perfection  is  only  enjoyed  by  the  residents  of  towns  or 
cities  subject  to  the  disease;  and  that  the  inhabitants  of  neighbour- 

i  Savaresi,  260;  Bally,  268,  334;  Dariste,  210;  Fontana,  170;  Arnold,  26;  N. 
Dickinson,  13  ;  Blair,  59. 


40-i  PNEUMONIA    AND 

ing,  but  more  elevated  and  salubrious  portions  of  the  country, 
though  less  prone  to  the  disease  than  strangers  from  cold  climates, 
are,  nevertheless,  liable  to  suffer  when  they  venture  in  an  infected 
place.1  Not  less  certain  is  it,  that  the  protective  influence  of  accli 
matization  is  lost  by  a  prolonged  residence  in  cold  climates  ;2  that 
the  children  of  the  natives  of,  and  acclimatized  to,  tropical  regions, 
do  not  enjoy  the  same  advantages  in  regard  to  protection  as  their 
parents,3  but  acquire  them  rapidly  as  they  advance  in  age ;  that  the 
residents  of  some  portions  of  tropical  regions  suffer  to  a  certain 
extent  from  the  disease,  on  removing  to  another  and  more  insalu 
brious  part  of  the  same  regions,4  or  even  to  one  differing  but  little 
in  point  of  salubrity.  We  find  also  that  individuals  acclimatized 
to  a  yellow  fever  locality  sometimes  lose,  to  some  extent,  the  pro 
tection  they  had  enjoyed,  by  a  long  exemption  of  that  locality  from 
local  sources  of  infection,  or  its  being  favoured,  during  several  suc 
cessive  summers,  with  a  cooler  and  purer  atmosphere  than  before  ;5 
and  that  the  same  results  obtain  when  individuals  change  their 
residence  to  places  where  the  effluvia  evolved,  though  not  more 
detrimental  to  health,  are  of  a  different  nature  from  those  to  which 
they  were  accustomed. 

So  far  as  regards  the  yellow  fever,  every  medical  writer,  from 
the  days  of  Towne,  Warren,  and  Pouppe  Desportes,  whose  works 
contain  the  earliest  professional  records  we  possess  relative  to  the 
fevers  of  tropical  climates,  has  dwelled  upon  the  protective  effects 
enjoyed  in  hot  regions  by  those  who  are  acclimatized  to  sickly  local 
ities.6  The  decided  advantages  resulting  therefrom  is  adverted  to 

1  Dariste,  37,  38  ;  J.  Clarke,  22  ;  Humboldt,  772,  773 ;  Keraudren,  24  ;  Imray,  Edin. 
Journ.  liii.  94 ;  Ferguson,  Med.-Chir.  Trans,  viii.  144 ;  Bancroft,  268. 

2  Rochoux,  40,  41  ;  Maher,  884;  Bally,  332,  340;  Arnold,  2G ;  Me  Arthur,  in  John 
son,  350 ;   R.  Jackson,  Fevers  of  Jamaica,  250 ;  H.  McLean,  187  ;  Fugnet,  345,  346 ; 
Frost,  Med.  Repos.  xii.  224 ;  Dariste,  37  ;  Savaresi,  256  ;  Bancroft,  268 ;  Frazer,  Med.- 
Chir.  Rev.  xiii.  347;  Rufz,  Med.  Exam.  iii.  109;  N.  Dickinson,  12;  Veicht,  111,  112; 
Hume,  267. 

3  Musgrave,  Med.-Chir.  Trans,  ix.  106,  107 ;  Rufz,  Med.  Exam.  iii.  106. 

4  Humboldt,  761,  771,  772;  J.  Clark,  1,  2;  Fugnet,  346. 

5  Chervin,  Report  on  Rufz's  Mem.  44. 

6  Williams.  51;    N.  Dickinson,  11,  66;   Edin.  Journ.   xxxvii.   154;    Henderson,  5; 
Hume,  237;  Wright,  Med.  Facts,  £c.  viii.  8;  Jackson,  Fevers  of  Jamaica,  250;  H. 
McLean,  187;  Madrid,  pt.  I.  32;  Savaresi,  260 ;  Bally,  268,332;  Dancer,  Med.  Assist. 
82;  Lefoulon,  20;  Leblond,  18,  227,  245;  Manson,  5;  Rochoux,  31  ;  Caillot,  13;  Che- 
vallier,  3;   Finkard,  ii.  472,  1st  ed. ;  Gilbert,  75,  76;  John  Hunter,  19;  Arnold,  20: 
Bancroft,  Seq.  41 ;  McArthur,  Dis.  of  Barbadoes,  Med.  Obs.  vii.  326 ;  Feixotto,  N.  Y. 


AUTUMNAL   FEVEES.  405 

by  Labat,1  Ulloa,2  Griffith  Hughes,3  Moreau  de  St.  Mery,4  Ilerrera,5 
Oviedo,6  and  other  early,  and  by  all  modern,  travellers  and  histo 
rians  ;  and  among  the  public  at  large  the  reality  of  the  privilege 
was  early,  and  continues  to  this  day  to  be,  viewed  as  placed  beyond 
the  possibility  of  doubt. 

The  whole  history  of  yellow  fever,  as  we  are  told  by  one  who 
has  thoroughly  investigated  the  subject,  shows  that  its  most  sus 
ceptible  subjects  in  tropical  climates  are  those  who  have  recently 
arrived  within  its  sphere,  particularly  the  inhabitants  of  northern 
climates,  and  that  the  predisposition  to  an  attack  increases  with  the 
degree  of  the  northern  latitude  from  which  the  stranger  has  arrived, 
and  the  shortness  of  the  interval  that  has  passed  since  he  left  the 
European  for  the  equatorial  region.  In  illustration  of  the  com 
parative  security  of  native  inhabitants  over  new-comers,  this  author 
—Dr.  Ferguson — adverts  to  the  experience  of  the  troops  at  Cape 
St.  Nicholas  Mole,  St.  Domingo,  among  whom,  soon  after  disem 
barking,  yellow  fever  broke  out  "  at  every  station  and  in  every 
place."  During  the  earlier  part  of  the  residence  of  the  British 
troops  there,  while  all  were  deeply  interested  to  stop  the  mortality, 
a  census  was  taken  of  the  inhabitants  of  the  town,  exclusive  of  the 
negro  slaves  and  the  white  soldiers,  when  they  were  found  to  be 
very  nearly  equal  in  numbers.  But  by  the  time  they  had  buried 
the  original  complement  of  1,500  men,  the  inhabitants  had  not  lost 
more  than  one  in  thirty  of  all  ages.7 

Dr.  Burrell  states,  that  "  of  thirty  regiments  that  arrived  in  the 
Windward  and  Leeward  Islands,  between  1816  and  1848,  ten  were 
attacked  with  black  vomit  fever  a  very  short  time  after  landing ; 
two  within  three  months  ;  eleven  within  twelve  months  ;  five  within 
two  years ;  and  two  within  three  years  of  their  arrival.  Of  thir 
teen  regiments,  which  landed  in  Jamaica  between  the  years  1816 
and  1834,  four  were  attacked  within  six  months;  seven  within 
twelve  months ;  and  two  within  eighteen  months.  From  1838  to 

Journ.  i.  417;  J.  Clark,  22;  Dariste,  21;  Evans,  276  ;  Gillkrest,  Cycl.  ii.  270;  Boyle, 
150;  Blair,  59;  Doughty,  65;  Trans.  Am.  Med.  Assoc.  v.  589. 

1  Nouveau  Voyage  en  Amerique,  ii.  264. 

2  Voy.  Hist,  de  1' Amerique  Meridionale,  i.  42.  3  Hist,  of  Barbadoes,  37. 

4  Loix  et  Constitutions  de  Saint  Domingue,  i.  375. 

5  Historia  General  de  los  echos  de  los  Castellanos  in  las  Islas,  &c.  de  Mar  Oceano, 
lib.  iii.  cap.  15,  lib.  x.  cap.  4. 

6  La  Historia  General  de  las  Indias,  lib.  v.  cap.  11. 

7  Ferguson's  Notes  and  Recollections,  150. 


4b6  PNEUMONIA    AND 

1848,  seven  regiments  arrived  in  that  island,  but  the  emancipation 
of  the  negroes  permitting  the  troops  to  be  quartered  in  the  mount 
ains,  a  few  cases  only  of  black  vomit  fever  appeared  within  that 
period,  in  two  of  them  soon  after  landing."1 

It  is,  however,  proper  to  remark  that,  general  as  the  rule  un 
doubtedly  is,  it  is  not  universal,  but  subject  to  occasional,  and, 
according  to  some  writers,  more  or  less  frequent  exceptions.2  Phe 
nomena  of  like  nature  are  observed  in  our  southern  cities — New 
Orleans,  Charleston,  Savannah,  Mobile — where  the  fever  is,  as  it 
were,  endemic,  and  the  heat  considerable  and  of  long  continuance, 
and  where  the  causes  of  insalubrity  assume  a  character  of  perma 
nency.  There,  as  in  tropical  regions,  the  natives  and  long  residents 
who  have  gone  through  the  process  of  acclimatization  remain,  with 
few  exceptions — principally  in  times  of  severe  epidemics,  when  the 
cause  is  very  powerful — free  from  the  disease,  which  exercises  its 
effects  among  strangers ;  so  exclusively,  indeed,  as  to  have  acquired 
in  Charleston,  and  some  other  places,  the  name  of  the  stranger's 
fever.  There,  as  within  the  tropics,  true  and  effective  acclimatiza 
tion  is  enjoyed  only  by  the  residents  of  localities  liable  to  the  dis 
ease,  and  not  by  those  who  reside  in  country  districts,  or  even  in 
the  suburbs  of  infected  cities.  Like  "West  Indians,  the  acclimatized 
inhabitants  of  our  southern  cities  lose  the  protection  they  possessed 
by  a  prolonged  residence  in  some  northern  place,  or  in  a  rural  dis 
trict  of  the  same  region;  while  their  children,  and  those  of  the 
natives,  are  as  prone  to  the  disease  as  strangers  themselves.3 

1  Second  Report  on  Quarantine,  9,  Lond.  1852. 

2  Griffith  Hughes,  37;  Chevalier,   6;  Gillkrest,  279;  Pugnet,   331,  346;  Caillot, 
142;  Bally,  332;  Savaresi,  134;  Rufz,  Examiner,  iii.  109;  Chervin,  Kept,  on  do.  32, 
44;  Musgrave,  Med.  Ch.-Tr.  is.  106  ;  Ib.  Med.  Ch.  R.  and  J.  iv.  981 ;  Imray,  Ed.  J. 
liii.  79 ;  Stevens,  195,  201  ;  Chisholm,  ii.  234  ;  Bancroft,  Seq.  Ferguson  Med.  Ch.  Tr. 
viii.  139-150;  Jackson,  11,  35;  Ib.  Outlines,  63;   Lempriere,   ii.  29;  Hunter,   19; 
Hillary,  120;  Catel,  6;  Desportcs,  i.  192;   Humboldt,  771,772;  Dancer,  82 ;  Guyon, 
28  ;  Warren,  4  ;  Furlong,  290 ;  Barry  in  Boyle,  270. 

a  Gros.  Rept.  7;  Girardin,  49,  51;  Thomas,  1st  ed.  77;  2d  ed.  22;  Michaud,  Voy. 
a  1'ouest  des  monts  Alleganys,  5  ;  Townsend  (for  fever  of  St.  Augustin),  361  ;  Ticknor, 
N.  A.  J.  iii.  218  ;  Barton,  Lecture  on  Acclimatement,  3;  Essay,  21 ;  Strobell,  139,  160  ; 
Bancroft,  188,  192  ;  Dickson,  Phil.  Med.  and  Phys.  J.  iii.  257 ;  Ramsay,  Rev.  of  Improv. 
39;  Ib.  Med.  Repos.  iv.  218;  Ib.  viii.  366-395;  Ib.  Hist,  of  S.  Car.  ii.  88;  Drayton, 
Rev.  of  S.  Car.  27,  28;  Dickson,  Bell's  J.  iv.  112;  Simons,  13;  Rept.  on  Fever  of 
N.  0.  of  1819,  pp.  35  and  43 ;  Ib.  on  Fever  of  1839,  p.  324 ;  Ib.  Fever  of  1820,  p.  6  ; 
Monette,  Western  J.  iv.  339 ;  Seagrave,  Med.  and  Phil.  Reg.  iii.  442  ;  Waring,  59 ; 
Daniel,  63;  Dupr6,  Hays's  J.  ii.  382  (N.  S.);  Harrison,  N.  0.  J.  130;  Dickson,  Es 
says,  343  ;  Lewis,  Fev.  of  Mobile,  N.  0.  J.  i.  417;  v.  43. 


AUTUMNAL   FEVERS.  407 

The  same,  though  to  a  more  limited  extent,  is  found  to  be  the 
case  in  various  of  our  less  southern  cities — as  Natchez,  Yicksburg, 
Grand  Gulf,  and  Norfolk,  where  the  protection  afforded  by  acclimati 
zation  is  not  sufficiently  effective  to  limit  the  inroads  of  the  fever  to 
strangers.  For  there  the  natives  and  long  resident,  while  less  liable 
than  the  latter,  are,  nevertheless,  far  from  being  entirely  exempt.1 
There  also,  as  well  as  in  the  cities  of  our  Middle  States  and  in  Eu 
rope,  where  nativity  or  long  residence  affords  no  protection,  the  in 
habitant  of  more  southern  or  tropical  localities,  in  which  the  yellow 
fever  prevails  endemically,  and  assumes  often  the  epidemic  charac 
ter,  exposes  himself  with  impunity  to  the  causes  of  the  disease  ;2 
and  there  also,  as  in  tropical  regions,  among  the  unacclimatized, 
the  disease  is  less  apt  to  attack  natives  of  southern  than  those  of 
northern  climates — less  Spaniards,  Portuguese,  and  French,  than 
Eussians,  Germans,  Swedes,  &c. 

ISTor  is  it  less  true  that  acclimatization  extends  its  influence, 
though  less  effectually  and  less  generally,  to  some  other  forms  of 
malarial  fevers.  In  England,  says  Dr.  Pinkard  (ii.  480),  "  the  har 
vest-men  and  strangers  who  go  into  the  fens  of  Kent  and  Lincolnshire 
in  the  autumn,  are  more  readily  attacked  with  the  endemical  fever 
of  those  provinces  than  the  inhabitants  who  constantly  reside  in 
the  atmosphere  which  causes  it."  The  protection  afforded  by  accli 
matization  against  endemic  remittent  is  found  to  be  enjoyed  in  this 
country,  often  giving  entire  immunity,  and  generally  lessening  the 
violence  of  the  disease.  Dr.  Coventry  mentions  it  in  reference  to 
our  lake  fever.3  It  is  also  recognized  as  regards  the  fever  of  our 
Southern  States — Georgia  and  South  Carolina.4 

The  term  acclimatization,  as  we  are  told  by  Dr.  Fenner,  is  just  as 
familiar  to  the  inhabitants  of  all  the  southern  portion  of  the  Missis 
sippi  Valley  as  it  is  to  the  citizens  of  New  Orleans,  "  and  is  used  to 

1  Merrill  Chapman's  J.  ix.  246 ;  Cartwright,  Recorder,  ix.  15 ;   Taylor  and  Hans- 
ford,  Mod.  Rep.  iv.  206  ;   Seldcn  and  Whitekead,  ib.  iv.  334;  Archer,  Recorder,  v.  61. 

2  Bancroft,   206;  Berthe,    167-169;  Fellowes,   59;    Gilpin,    Med.-Ch.   T.  v.   317; 
Pym,  25;  Arejula,  183,  330,  446;  Pariset,  14,  15;  Caisergues,  200,  201;  Rochonx, 
123  ;  Sliecut,  108 ;  Seamen,  Fev.  of  1795  in  N.  Y.  7  ;  A.  Hosack,  10  ;  Warren,  in  Tyt- 
ler,  501  ;  Potter,  1G2;  Drysdale,  Med.  Mus.  i.  39,  40;  Dalmas,  100;  Ramsay,  Edin. 
J.  viii.  429;   Deveze,  55;  Rush,  iii.  80;  Currie,  12;  Ib.  Barton's  J.  ii.  38;  Cathrall, 
6 ;  Nassy,  38  ;   Carey,  67 ;  Condie  and  Folwell,  v.  vi.  ;  Caldwell,  Fever  of  1805,  79  ; 
Facts  and  Obs.  by  College  of  Phys.  19  ;  O'Halloran,  119;  Bartlett,  461. 

3  Address,  42. 

4  Pendleton,  Charleston  J.  vii.  451 ;  Lewis,  N.  0.  J.  i.  323. 


408  PNEUMONIA    AND 

( 

express  the  same  idea,  viz.  that  persons  coming  from  a  northern 
climate  and  settling  there,  are  very  liable  to  have  attacks  of  fever 
during  the  first  two  or  three  years,  but  afterwards  become  quite 
exempt.1  The  same  power  of  resistance  to  the  action  of  disease 
by  the  acclimatized  has  long  been  recognized  in  other  countries — 
in  South  America,  in  Italy,  &c.2  Lancisi  says  that  they  who  are 
born  and  reared  in  the  neighbourhood  of  marshes  enjoy  good 
health  in  an  unhealthy  atmosphere.  And  children  can,  by  degrees, 
be  accustomed  to  take  considerable  doses  of  the  poison,  beginning 
with  small  ones  at  first.  "  By  this  power  of  habit  does  it  happen 
that  man  can  live  upon  the  small  islands  in  those  ponds  and  lakes ; 
and  that  even  the  floating  islands  which  the  winds  drive  about 
from  place  to  place,  have  their  human  inhabitants.  For  Secundus, 
in  his  description  of  the  Lake  of  Yadimon,  declares  he  has  seen 
them.  P.  Cabasus  has  observed  them  in  the  marshes  of  Ferrara, 
and  I  myself  have  seen  them  in  the  Alban  Lake."3 

Dr.  A.  Brown,  whose  observations  have  reference  evidently  as 
much  to  the  common  remittent  as  to  the  yellow  fever  of  tropical 
climates,  after  stating  that  a  soldier,  or  stranger,  cannot  be  con 
sidered  inured  to  such  climates  by  a  residence  of  less  duration  than 
from  three  to  five  years,  remarks  that  if  the  latter  period  be  adopt 
ed,  as  affording  a  greater  probability  that  a  regiment  has  passed 
through  at  least  one  epidemic  season,  on  turning  to  table  76,  p.  92, 
of  the  Statistical  Eeport,  we  find  that  the  average  mortality,  during 
the  five  years  of  service,  was  in  the  ratio  of  147.7  per  1,000,  whereas, 
in  the  second  five  years,  it  was  104.7  per  1,000  of  the  strength.  If 
we  now  examine  table  77,  p.  93,  from  which  the  great  epidemic 
years  are  excluded,  we  find  that  the  mortality  in  the  first  five  years 
of  service  was  102  per  1,000,  and  in  the  second  five  years  82  per 
1,000  of  the  strength.  From  this  we  perceive  that  the  immunity,  or 
advantage  enjoyed  by  the  acclimatized,  is  not  confined  to  epidemic 
years/  though  in  such  it  appears  to  be  about  twice  as  great  as  in 
ordinary  years ;  the  diminution  of  the  mortality,  amounting  in  the 
former  to  four,  and  in  the  latter  to  two  per  cent,  of  the  force 
respectively.4 

1  Southern  Mod.  Rep.  i.  32. 

2  Weatherham,  Celle  Hyg.  cles  Pays  Cliauds,  70  ;  Macculloch  on  Remittent  Fever,  i. 
10,  11  ;  Johnson  on  Trop.  Climates,  151. 

3  De  Xox  Pal.  Effl.  lib.  i.  cap.  v.  21. 

4  Second  Report  on  Quarantine,  294,  295. 


AUTUMNAL   FEVERS.  409 

The  following  remarks  of  Sir  Gilbert  Blane  on  this  subject, 
though,  applying  only  to  the  "Walcheren  fever,  may  be  appropriately 
introduced  here:  "One  of  the  most  important  circumstances  in 
the  operations  of  marsh  miasmata  on  the  human  body,  is  the  power 
of  habit  in  mitigating  its  influence.  The  natives  are  a  robust 
people ;  they  are  of  a  very  wan  and  sickly  hue,  with  flaccid  flesh, 
and  have  all  suffered  more  or  less  from  the  bad  air  which  they 
breathe.  The  children  of  both  sexes  are  very  subject  to  glandular 
and  abdominal  complaints;  and  the  adults,  particularly  those  of 
the  lower  orders,  have  all  of  them,  sometime  or  other  in  the  course 
of  their  lives,  laboured  under  the  endemic  intermittent.  They  are, 
however,  infinitely  less  subject  to  intermittent  fevers  than  strangers." 
"  These  strangers  are  also  variously  affected,  according  to  the  dis 
trict  from  which  they  come.  It  was  found,  that  of  the  British 
troops,  the  natives  of  mountainous  countries  and  dry  soils,  such  as 
the  Highlands  of  Scotland,  were  more  frequently  affected  than  the 
natives  of  flat  and  moist  districts,  such  as  Lincolnshire."  Sir  Gil 
bert  mentions  the  case  of  a  French  regiment,  "  which  suffered  in 
the  second  year  of  its  being  there  only  one-half  of  the  sickness  and 
mortality  which  it  suffered  the  first  year,  and  hardly  suffered  at  all 
the  third."1  Monfalcon  informs  us  that  the  same  fate  attends  the 
inhabitants  of  the  high  and  healthy  localities  in  the  vicinity  of  the 
fenny  districts  of  the  Bresse,  who  visit  the  plains  in  quest  of  work 
during  harvest  ;2  and  similar  statements  are  made  by  Fodere  in 
regard  to  the  peasantry  of  Romagna,  Moclena,  and  Ferrara.3 

From  all  the  accounts  that  have  been  transmitted  to  us  of  the 
sickness  and  mortality  of  French  troops  in  Algeria,  as  well  as  of 
the  results — in  a  sanitary  point  of  view — of  the  colonisation  of 
that  country,  we  learn,  that  the  Europeans,  from  the  north 
particularly,  experience  great  difficulty  in  becoming  acclimatized 
there,  and  that  their  chances  of  success  in  that  respect  are,  to  say 
the  least,  extremely  precarious.4  Diseases — miasmal  fevers  par 
ticularly — carry  off  a  large  number  of  the  troops ;  a  larger  number 
are  soon  invalided,  and  the  rest  must,  sooner  or  later,  be  sent  back 
to  France  to  renovate  their  constitutions.  While  such  is  the  result 
among  the  European  troops,  the  natives  of  the  country,  and  the 

1  Kept,  on  Mission  to  Walcheren,  Dissertations,  i.  223,  224,  225. 

2  Tvftite  clcs  Marais,  196.  3  Med.  Led.  v.  167. 

4  Pcrier,  An.  d' Hygiene,  xxxiii.  307 ;  Boudin,  ib.  xsxvi.  381 ;  Maillot,  Fierres  Int. 
205  ;  Haspel  Mai.  clc  PAlgerie,  i.  78. 


410  PNEUMONIA    AND 

Arabs  enrolled  in  the  army,  and  doing  duties  similar  to  those 
assigned  to  the  former,  remain  free  from  fever,  or  take  it  in  its 
mildest  forms.  Similar  results  are  obtained  along  the  shores  of 
the  Keel  Sea ;  for  while  the  natives  are  exempt  from  the  fevers  of 
the  country,  and  individuals  of  the  Indo-Ethiopian  race  easily  be 
come  inured  to  the  climate,  the  Europeans  are  with  extreme  diffi 
culty  acclimatized.1 

Chomel  and  other  writers  state  that  typhoid  fever  attacks  more 
readily  those  who  have  been  only  a  short  time  in  Paris,  while  it 
in  a  great  measure  spares  the  natives  of  that  city.  It  appears  from 
a  table  published  by  Dr.  Davidson,2  that  among  568  eruptive  cases 
of  typhus,  in  whom  this  point  was  ascertained  at  Glasgow  Fever 
Hospital  from  November  1,  1838,  to  November  1,  1839,  176  were 
natives  of  that  city,  and  392  were  strangers  ;  206  of  these  stran 
gers  had  resided  in  Glasgow  only  from  one  day  to  two  years,  and 
186  from  two  to  twenty  years  and  upwards.  Dr.  D.  draws  the 
following  deductions  :  1.  That  strangers  are  more  liable  to  become 
infected  with  typhoid  fever  than  native  residents.  2.  That  the 
majority  of  strangers  are  infected  within  a  comparatively  short 
period  of  their  residence  in  Glasgow.  3.  That  a  minor  portion  of 
strangers,  like  the  natives  of  Glasgow,  may  escape  infection  for 
many  years,  and  yet  be  afterwards  attacked.3 

In  1851,  typhoid  fever  prevailed  epidemically  at  Montpellier, 
especially  among  the  troops  of  the  garrison.  It  was  principally 
rife  among  those  who  had  not  been  long  in  the  place.  So  far  as 
civilians  were  concerned,  it  more  generally  attacked  workmen 
going  the  rounds  of  France  (faisant  leur  tour  de  France),  and 
recently  arrived,  as  also  people  from  the  country  who  had  come  to 
work  at  the  crops  and  the  vintage ;  in  a  word,  the  disease  selected 
its  victims  among  individuals  unacclimatized  to  the  place.4 

Having  established  the  fact  of  the  immunity — complete  or  par 
tial — obtained  from  the  action  of  the  causes  of  autumnal,  yellow, 
and  other  fevers,  by  long  residence  in  malarial  and  infected  locali 
ties,  I  am  prepared  to  ask  what  analogy  there  exists  in  that  respect 
between  those  fevers  and  pneumonia.  In  regard  to  the  latter,  it  is 
undoubtedly  true,  as  we  have  seen,  that  it  prevails  more  frequently 

1  A.  Roche,  An.  d'Hyg.  xxxiii.  30. 

2  Thackeray,  Prize  Essay  on  the  Causes  of  Fever,  G8. 

3  See  also  Bartlett,  102. 

4  Anglada,  Traite"  de  la  Contagion,  i.  121. 


AUTUMNAL    FEVERS.  411 

in  some  orders  of  climates  than  in  others ;  but  whatever  be  the  extent 
of  its  prevalence,  it  is  not  less  certain  that,  wheresoever  it  does  show 
itself,  no  class  of  the  population  is  exempt  from  its  attacks.  Accli 
matization  exercises  no  influence  in  that  respect ;  natives  and  long 
residents  are  as  subject  to  it — individual  constitutions,  tempera 
ments,  idiosyncrasies,  habits  of  exposure  to  atmospheric  vicissi 
tudes,  and  other  circumstances  being  the  same — as  strangers  and 
new  residents. 

Pneumonia  and  autumnal  fevers  affect  different  races. — The  two  dis 
eases  do  not  differ  less  essentially  in  regard  to  the  force  with  which 
they  affect  the  several  races.  It  can  scarcely  be  necessary  to  re 
mark,  that  in  all  countries  subject  to  malarial  fevers  generally — 
whether  the  true  and  genuine  yellow  fever,  or  ordinary  autumnal 
or  periodic  fever — the  black  race  is  to  a  greater  or  less  extent  ex 
empt  from  the  disease.  So  far  as  regards  the  former  fever,  the 
immunity  enjoyed  by  negroes  born  and  raised,  or  acclimated,  in 
countries  where  the  disease  is  endemic — the  West  India  Islands 
and  the  coasts  of  Mexico,  and  Southern  America — and  especially 
by  the  natives  of  Africa,  has  been  noticed  and  recorded  by  almost 
every  writer.  This  immunity  they  possess  in  much  greater  perfec 
tion  than  the  whites  born,  bred,  or  acclimatized  in  the  same  locali 
ties;  and  hence  may  be  supposed  to  owe  a  large  share  of  it  to  the 
peculiarity  of  their  organization.  Few  among  them  take  the  fever ; 
and  those  that  do  so,  have  it  generally,  though  not  universally,  in 
the  mildest  form.1  If,  like  the  whites,  they  occasionally  lose  this 
protection  by  a  prolonged  residence  in  cold  climates,  and  take  the 
disease  on  their  return  within  the  tropics,  the  occurrence  is  less 
frequently  noticed  among  them,  and  the  attack  is  of  a  milder  cha- 

1  Custin,  in  Duncan's  Com.  v.  149  (Am.  eel.);  Moseley,  146;  Lempriere,  ii.  29; 
Bancroft,  51,  270-272;  Jackson,  Fevers  of  Jamaica,  250;  Hunter,  20,  308;  Puguet, 
346,  347  ;  Savarcsi,  256-258  ;  Frost,  Med.  Repos.  xii.  223  ;  Rufz,  Med.  Examiner, 
iii.  129 ;  Ib.  Chervin's  Rep.  30 ;  Ferguson's  Med.-Ch.  Trans,  viii.  121 ;  Ib.  Med.-Ch. 
Rev.  Jan.  1840,  p.  300 ;  Ib.  Recol.  142 ;  H.  McLean,  187 ;  Humboldt,  772 ;  Hume, 
237,  238  ;  Chisholm,  i.  142,  225;  Bourgeois,  Maladies  de  St.  Domingue  in  Voy.  Inte- 
ressants,  &c.  417 ;  J.  Clarke,  3  ;  Caillot,  14  ;  Manson,  5 ;  Bally,  269,  303-305  ;  Ar 
nold,  34;  Dickinson,  12,  48;  Evans,  276;  Me  William's  Niger  Exped.  128;  Ib.  Fev. 
of  Boa  Vista,  93,  94;  Doughty,  50  ;  Warren,  14;  Wright,  Med.  Facts,  &c.  vii.  8; 
Henderson,  7;  Bryson,  54;  Pinkard,  ii.  484;  Copland,  iii.  151;  Leblond,  18,  245; 
McCabe's  Rep.  on  Dis.  of  Warm  Climates,  43 ;  Diction  de  Med.  xix.  151. 


412  PNEUMONIA    AND 

racter  f  and  if  blacks  removing  there  from  northern  climates  suffer 
from  the  disease,  sometimes  even  in  its  most  aggravated  forms,2  the 
effect  is  far  less  frequently  observed  among  them  than  among  the 
whites. 

In  our  Southern  States,  the  blacks  have  always  exhibited  the 
same  superiority  in  regard  to  immunity  over  the  whites — subject, 
however,  to  the  same  modifications — not  only  in  those  sections  of 
country  or  in  cities  where  the  protection  afforded  to  the  latter  by 
acclimatization  is  very  general,  if  not  entire,3  but  in  those  places, 
as  Natchez,  Washington  (Miss.),  Norfolk,  &c.,  where  that  protection 
is  comparatively  limited.4  In  our  Middle  States,  the  blacks  have 
usually — though  not  always — escaped  entirely,  and  among  the  few 
affected,  the  disease  has  almost  invariably  assumed  a  mild  and 
tractable  character.  For  proof  of  this,  I  confidently  appeal  to  the 
records  of  the  epidemics  by  which  this  city  has  been  visited;5  while, 
if  we  cross  the  Atlantic,  and  inquire  how  matters  stand  in  that 
respect  in  the  cities  of  Spain  and  in  Leghorn,  we  shall  find  that 
there  also  the  blacks  have  almost  universally  escaped.6 

Nor  is  it  less  a  fact  placed  beyond  dispute,  that  blacks  are  much 
less  liable  than  whites  to  other  forms  of  miasmal  fevers,  and  that, 
when  attacked,  they  have  the  disease  in  a  milder  form.  This  com 
parative  unsusceptibility  was  noticed  in  the  West  Indies  from  the 
period  of  the  earliest  introduction  there  of  negroes.  It  did  not 
escape  the  attention  of  Herrera  (lib.  3  and  10),  and  other  of  the 
early  historians,  whose  observations  on  the  subject  have  been  con 
firmed  by  every  subsequent  writer  on  the  climate  and  diseases,  not 
only  of  those  Islands,  but  also  of  every  other  portion  of  tropical 
regions.  "  The  negro,"  says  Dr.  Ferguson,  "  may  also  be  said  to 

1  Jackson,  Dis.  of  Jamaica,  250;   H.  McLean,   187  ;  Lempriere,  ii.  29;  Bancroft, 
176 ;  Savaresi,  op.  cit. ;  Gillkrest,  Cyclop,  ii.  279. 

2  Frost,  op.  cit.  224,  note ;   Ferguson,  Bell's  J.  iii.  14. 

3  Lining,  Essays  and  Obs.  Fhys.  and  Literary,  ii.  409;  Ramsay's  Hist.  S.  C.  ii.  85 ; 
Simons,  14;  Ib.  Address,  12;  Daniel,  65;   Thomas,  77;  Chalmers,  i.  39;  Sengrave, 
Med.  and  Phil.  Reg.  iii.  420;  Fever  of  N.  0.  in  1839,  in  Rev.   Mcd.  for  1840,  325; 
Ticknor,  N.  A.  J.  iii.  218;    Dickson,  345  ;   Lewis,  N.  0.  J.  i.  410;  Burtlctt,  345. 

4  Cartwright,  Rec.  9;  Seldcn  and  Whitelicad,  Med.  Repos.  iv.  335;  Merrill,  Chap 
man's  J.  ix.  246;  Archer,  Recorder,  v.  61 ;  Monette,  Am.  J.  i.  245  ;  Hogg,  Western 
J.  i.  413-416;  Valentin,  90. 

5  Rush,  iii.   81;  Caldwell,   Memoirs,   210;  Cathrall,  6;   Currie,   13,  14;  Wood,  i. 
307  ;  Deveze,  108,  109 ;   Folwell,  57  ;  Carey,  85. 

6  Berthe,  1G7;   Caisergue,    191-200;  Burnet,   242;  Rept.    of  the   Mod.   Acad.    of 
Barcelona,  23 ;  Pariset,  Fievre  de  Barceloue,  542. 


AUTUMNAL   FEVERS. 


413 


be  fever  proof;  and  the  marshy  savannas,  which  lie  low  and 
scattered  and  unventilated,  prove  to  him  the  most  healthful  abode. 
From  peculiarity  of  idiosyncrasy,  he  appears  to  be  proof  against 
endemic  fevers.  To  him  marsh  miasmata,  which  so  infallibly  de 
stroy  our  white  soldiers,  are  in  fact  no  poison.  The  warm,  moist, 
low,  and  leeward  situations,  where  these  pernicious  exhalations  are 
generated,  prove  to  him  congenial  in  every  respect.  lie  delights 
in  them;  for  he  there  finds  life  and  health,  as  much  as  his  feelings 
are  abhorrent  to  the  currents  of  wind  that  sweep  the  mountain  tops, 
where  alone  the  whites  find  security  against  tropical  diseases;  but 
the  black,  when  placed  there,  is  almost  infallibly  struck  with  the 
bowel  and  heart  complaints  which  prove  so  fatal  to  him."1 

The  comparative  average  prevalence  of  fever  among  the  European 
and  black  troops  of  the  British  army  in  the  West  Indian  and 
African  commands,  and  the  like  mortality  from  the  same  disease, 
afford  a  striking  illustration  of  the  difference  of  susceptibility  in 
question.  Thus,  we  find  that,  during  a  period  of  twenty  years, 
from  1817  to  1836,  inclusive,  the  result  was  as  follows: — 

Strength.  Fevers.             Deaths. 

Jamaica  Command. 

Whites     ....  51,567  46,922          5,253 

Blacks      ....  5,729  634              47 

Bahamas. 

Whites     ....  535  506              85 

Blacks      ....  7,102  2,260              40 

Honduras. 

Whites     ....  320  221               27 

Blacks      ....  4,356  1,100               19 
Windward  and  Leeward. 

Whites     ....  86,661  62,163          3,195 

Blacks      ....  40,934  6,856             190 

Mauritius. 

Whites     ....  30,515  4,707              53 

Blacks      ....  1,395  121 

Sierra  Leone. 

Whites     ....  1,843  2,600            756 

Blacks      ....  7,581  405              18 

1  Ferguson's  Recollections,  Black  Troops  in  the  W.  I.  207,  209.     See  also  McCabe, 
op.  cit.  43. 


414  PNEUMONIA    AND 

The  following  table  will  show  the  comparative  ratio  of  mortality 
from  the  disease,  per  1,000  of  mean  strength,  in  the  various  West 
India  Islands,  and  other  commands : — 

Windward  and  Leeward  Islands.                                Whites.  Blacks. 

English  Guiana     ....       52.2  8.5 

Trinidad 61.6  3.2 

Tobago 104.1  8.6 

Grenada 26.3  4.8 

St.  Yincent 11.2  .9 

Barbadoes 11.8  3.8 

St.  Lucia f     63.1  5.2 

Dominica 19.3  7.7 

Antigua 14.9  1.7 

St.  Christopher     ....       12.1  10.5 


Average  of  whole  command  36.9  4.6 

Jamaica 101.9  8.2 

Bahamas 159.1  5.6 

Honduras 81.0  4.4 

Sierra  Leone         ....  410.2  2.4 

Mauritius 1.7  0.0 

Ceylon 25.7  1.1 

In  all  those  localities,  we  find  the  average  number  of  fever  cases 
among  white  troops  far  exceeding  that  among  the  blacks,  while  the 
mildness  of  the  disease  among  these  is  evinced  by  the  smallness  of 
the  mortality .  they  suffered,  compared  to  that  among  their  Cau 
casian  comrades.  In  speaking  of  the  sickness  of  the  British  troops 
in  the  Sierra  Leone  command,  Major  Tullock  says :  "  Fatal  as  the 
fevers  of  this  colony  have  proved  to  the  whole  troops,  the  blacks 
have  been  but  little  affected  by  them ;  indeed,  the  attacks  have  been 
fewer,  and  the  deaths  have  not  materially  exceeded  the  proportion 
among  an  equal  number  of  white  troops  in  the  United  Kingdom  or 
other  temperate  climates.  Though  fevers  are  much  more  frequent 
and  fatal  among  the  whites  than  in  the  West  Indies,  the  reverse  is 
the  case  with  the  blacks."1  By  another  writer,  Dr.  Bryson,  we  are 
told  (p.  22),  that  the  natives  of  Fernando  Po  are  a  healthy,  athletic 
race  of  people,  yet  this  island  is  more  detrimental  to  health  than 

1  Dis.  and  Mort.  of  the  British  Army  (Western  Africa),  1G. 


AUTUMNAL   FEVERS.  415 

any  spot  in  the  known  world;  even  the  Africans  from  the  continent 
are  always  sickly  here.  Of  thirty  white  mechanics  who  arrived 
in  November,  1827,  all  had  the  fever  in  a  very  short  time;  the 
number  that  died  cannot  be  ascertained.  A  few  were  invalided, 
and  five  only  remained  in  June,  1828  (pp.  22,  69,  70).1  The  reader 
is  doubtless  already  conversant  with  the  universal  exemption  of  the 
Kroomen,  not  only  from  the  common  remittent  of  the  coast,  but 
from  every  deadly  fever,  as  a  circumstance  rendering  them  of  ex 
treme  utility  to  the  coast  squadrons,  and  to  all  traders. 

The  negroes  of  our  Southern  States  are  but  little  subject  to  ma 
larial  fevers;  and,  while  on  the  rice  plantations  of  Georgia  and 
South  Carolina,  the  white  cannot  reside  for  fear  of  the  country  fever, 
the  negro  works  with  impunity,  exposed  to  the  rays  of  the  broiling 
sun,  and  to  the  humidity  of  the  flooded  fields.2  Dr.  Ketchum,  in  a 
report  on  the  topography,  sanitary  condition,  and  vital  statistics  of 
Mobile,  says  of  the  slaves  owned  by  the  Creole  population :  "  They 
seem  to  be  entirely  exempt  from  the  attacks  of  yellow  and  bilious 
fevers."3  Another  writer,  Dr.  Pendleton,  of  Georgia,  remarks: 
"  That  the  African  is  less  susceptible  to  malarious  influences  than 
the  white,  I  have  believed  from  general  observation  heretofore. 
Although  more  exposed  to  the  cold  dews  and  hot  sun  of  autumn, 
as  well  as  having  more  filth  about  their  habitations,  they  seem  to 
be  less  liable  to  periodic  fevers,  and  more  readily  recover  than  the 
white."  In  illustration  of  this,  Dr.  P.  shows  that,  in  the  county  he 
resides  in,  the  number  of  idiopathic  fevers  among  the  whites  greatly 
predominates  over  that  among  the  blacks ;  being  in  the  proportion 
of  14.5  to  10.44  After  remarking  that  congestive  fever  prevailed 
epidemically  in  his  neighbourhood,  Dr.  Lewis,  of  Mobile,  says: 
"  There  were,  in  my  professional  circle,  two  blacks  to  one  white  ; 
yet  I  did  not  see  a  single  case  of  congestive  fever  in  a  negro,  nor 
did  I  hear  that  any  died  of  the  disease  in  that  section  of  country. 
I  have  made  inquiries  of  several  medical  gentlemen  who  have  long 
been  practising  in  the  country;  their  experience  does  not  materially 
differ  from  mine ;  the  fact  is,  that  the  remarkable  exemption  from 
yellow  fever,  which  this  race  enjoys,  extends  in  a  great  measure  to 

1  See  also  Darnell's  Topography  of  the  Coast  of  Guinea,  134. 

2  Daniel,  64,  65 ;  Wood,  i.  240-267. 

3  Former's  Southern  Med.  llept.  ii.  307. 

*  General  Report  on  the  Topography  of  Middle  Georgia,  Charleston  Journ.  vii.  455. 


416  PNEUMONIA    AND 

all  the  malarious  fevers  of  hot  climates ;  they  may  all  have  inter 
mittent  and  light  bilious  fevers,  as  well  as  the  milder  grade  of  yel 
low  fever  ;  but  it  is  only  under  extraordinary  circumstances  that 
these  diseases  affect  them  so  seriously  as  to  cause  death."1  Dr. 
Lewis  remarks,  that  any  one  who  weighs  calmly  all  the  influencing 
circumstances  by  which  plantation  negroes  are  beset,  the  vicissi 
tudes  of  heat  and  cold  to  which  they  are  hourly  exposed,  such  as 
running  from  the  fields  during  a  shower  of  rain,  sleeping  in  wet 
clothes,  on  a  cold  bluff,  or  earthen  floor,  from  which  they  arise  with 
a  pain  in  the  head,  or  cold  stiffened  limbs;  their  inattention  as  to 
the  preparation  of  their  food,  which  they  eat  in  a  crude,  half-cooked 
state,  it  will  be  found  that  these,  and  not  malaria,  are  the  chief 
causes  of  the  mixed  undefinable  fevers,  dysenteries,  and  diarrhoeas 
that  annoy  them.2 

Now,  if  with  all  these  facts  before  us  as  to  the  insusceptibility 
of  the  African  race  to  malarial  fevers,  we  inquire  into  the  preva 
lence  of  pneumonic  inflammation  among  them,  we  shall  find  but 
little  calculated  to  justify  the  idea  of  the  close  alliance  of  the  two 
diseases ;  for  experience  teaches,  that  the  bracks  are  as  subject  as 
the  whites  to  pneumonia,  if,  indeed,  they  are  not  more  so. 

Dr.  Kobert  Jackson,  whose  authority  no  one  will  attempt  to 
impugn,  says  of  pneumonia :  "  It  is  the  most  common  form  of  dis 
ease  that  occurs  among  the  transplanted  natives  of  Africa,  whether 
such  as  are  enrolled  in  the  lists  of  the  army,  or  such  as  are  reserved 
for  field  labour ;  particularly  in  islands  of  a  dry  air  and  broken 
surface."3 

In  illustration  of  this,  let  the  reader  examine  the  results  ob 
tained  among  the  African  portion  of  the  British  army,  in  tropical 
climates,  and  compare  them  with  those  referred  to  relatively  to 
fevers,  and  he  will  at  once  convince  himself  of  the  correctness  of 
the  statement. 

1  Lewis  on  the  Yellow  Fever  of  Mobile,  N.  0.  Journ.  i.  417;  Duperier,  ib.  vii.  575 : 
Grier,  N.  0.  Journ.  ix.  430. 

2  In  a  relcve  of  1,03G  cases  of  malarial  fever  occurring  from  1843  to  1848,  and  fur 
nished  by  Dr.  Eoling,  in  a  report  on  the  epidemics  of  Alabama,  there  were  G71  whites 
and  365  blacks  and  mulattoes. — Trans.  Am.  Med.  Asaoc.  v.  4^5. 

3  Sketch,  ii.  83,  84. 


AUTUMNAL   FEVERS.  417 

Aggregate          Cases  pneu.     Deaths.     Ratio  of  cases 
strength.  and  pleu'y.  in  1,000. 

Jamaica  command,  1817-36. 

Whites    .         .         .  51,567  736  15             13.4 

Blacks     .         .         .  5,729  75  17             13.1 

Bahamas. 

Whites    ...  535  3  2              5.6 

Blacks     .         .         .  7,102  176  15             24.6 

Honduras. 

Whites     ...  320  2  6.24 

Blacks     .         .         .  4,356  43  3              9.7 

Windward  and  Leeward. 

Whites    .         .         .  86,661  1,975  113             20.5 

Blacks     .         .         .  40,934  1,823  160            44,5 

Mauritius. 

Whites    .         .         .  30,515  726  39             23'8 

Blacks     .         .         .  1,395  30  2             21«6 

Sierra  Leone. 

Whites    .         .         .  1,843  15  1               8.14 

Blacks     .         .         .  7,581  81  12             10.69 

The  frequency  of  pneumonia  and  kindred  complaints  among  the 
blacks  of  tropical  climates,  has,  indeed,  been  noticed  time  after  time, 
and  recorded  by  the  best  authorities;1  and  has  not  less  attracted 
attention  in  this  country,  whether  the  disease  appear  in  its  ordinary 
inflammatory  form,  or  in  that  denominated  pneumonia  typhoides.2 
In  middle  Georgia,  as  shown  by  Dr.  Pendleton,  while  the  diseases  of 
the  respiratory  organs  prevail  among  the  whites  in  the  proportion 
of  13.8  per  cent.,  the  same  diseases  extend  among  blacks  at  the 
rate  of  28.0  per  cent.3  Dr.  Lewis,  in  like  manner,  represents  the 
various  forms  of  pneumonia  as  being  particularly  prevalent  among 
the  negroes  of  the  South,  especially  in  Middle  and  South  Alabama.4 
"  Pneumonia  without  subjective  symptoms,"  says  Dr.  Cartwright, 
"  is  very  common  among  them  (the  blacks).  Intercurrent  pneu 
monia  is  more  common  among  them  than  any  other  class  of  people. 

1  Desportes,  i.  5,  33,  92,  ii.  273;  Dazille,  113;  Leblond  on  Fever,  77;  Levacher, 
39;  Campct,  210,  211  ;  Daniell,  Topog.  of  Gulf  of  Guinea,  53,  94;  Bajon,  Mala-d.  &c. 
de  Cayenne,  i.  73. 

2  Fenner's  Southern  Med.  Repts.  ii.  432  ;   Charleston  Med.  Journ.  vi.  838. 

3  Fenner's  Repts.  i.  335.  4  Med.  Hist,  of  Alabama,  N.  0.  Journ.  iv.  33. 

27 


418  PNEUMONIA    AND 

It  is  met  with  in  typhoid  fevers,  rheumatism,  and  hepatic  derange 
ments,  to  which  they  are  very  liable  in  the  cold  season."1  Accord 
ing  to  Dr.  Harris,  of  Alabama,  negroes  were  attacked,  during  an 
epidemic  of  pneumonia  which  prevailed  in  Wetumpka,  in  1851,  in 
"somewhat  greater  proportion  than  the  whites,  and  among  the 
former  the  mortality  was  decidedly  greater  than  among  the  latter."2 
Dr.  Grier  has  also  called  attention  to  the  same  circumstance,  and 
remarks,  "  that  the  negro  is  more  liable  to  pneumonic  attacks  than 
the  white  race,  and  the  complaint  proves  more  fatal  to  them."3 

Difference  of  susceptibility  of  the  two  sexes. — We  are  scarcely  less 
justified  in  seeking  for  proof  of  dissimilarity  between  the  two  dis 
eases  in  the  difference  of  liability  of  each  of  the  two  sexes.  As 
regards  pneumonia,  males  may  furnish  generally  a  larger  number 
of  cases  than  females,  and  the  disease  in  them  may  assume  fre 
quently  its  most  severe  character.  But  there  are  facts  sufficient  on 
record  to  warrant  the  conclusion,  that  this  greater  prevalence  of  the 
disease  in  the  first-mentioned  sex  is  not  the  result  of  an  inherent 
susceptibility;  but  is  due,  when  it  occurs,  to  a  series  of  fortuitous 
and  modifying  causes;  more  particularly  to  the  circumstance  that 
males — owing  to  the  nature  of  their  avocations  and  mode  of  life — 
are  usually  more  exposed  than  females  to  the  causes  of  pulmonary 
inflammation ;  and  that  in  places  where  exposure  is  equal  in  both 
sexes,  the  disease  manifests  itself  as  frequently  in  the  one  as  in  the 
other.  On  this  subject,  statements,  for  which  we  are  indebted  to 
Grisolle,4  Chomel,5  Williams,6  Yalleix,7  and  others,  can  leave  no 
doubt  on  the  rnind  of  the  unbiased  inquirer,  so  far  as  regards 
Europe.  For,  besides  that  in  rural  districts,  where  women  are  as 
much  exposed  as  men,  the  disease  does  not  manifest  itself  more  fre 
quently  in  one  sex  than  in  the  other;  in  prisons,  for  example, 
where  the  material  conditions  of  life  are  similar  for  all  the  inmates, 
the  number  of  females  attacked  equals  that  of  males.  Nor  should 
it  be  forgotten  that  among  children,  who  are  exposed  to  the  same 

1  On  the  Philos.  of  the  Negro  Constitution,  N.  0.  Journ.  ix.  205. 

2  Rept.  on  the  Epid.  of  Alabama,  Trans,  of  Am.  Med.  Assoc.  v.  373 ;  see  also  Drake, 
N.  0.  Journ.  i.  584. 

3  N.  0.  Journ.  ix.  430.  4  Op.  tit.  114. 
5  Diet,  de  Med.  xxv.  161.                          6  P.  289. 

7  Guide  du  Med.  Prat.  ii.  259. 


AUTUMNAL    FEVERS.  419 

influences,  the  disease  has  usually  been  found  to  bear  with  equal 
severity  on  the  two  sexes.  Similar  observations  have  been  made 
in  this  country  and  elsewhere. 

In  regard  to  malarial  fevers  of  various  grades  or  varieties,  from 
the  simple  intermittent  to  the  deadly  and  malignant  yellow  fever, 
we  arrive  at  different  conclusions.  In  these,  males,  excepting  in 
some  epidemics  mentioned  by  Musgrave  (106),  Catel  (10),  Rufz 
(32),  and  under  circumstances  of  a  special  kind,  are  more  frequently 
affected  than  females ;  and,  as  a  general  rule,  it  may  be  stated  that 
when  these  are  attacked,  they  have  the  disease  in  a  milder  form. 
That  this  comparative  immunity  on  the  part  of  females  may,  in 
some  mensure,  be  due  to  their  more  temperate  habits,  and  to  their 
being  usually  less  exposed  to  the  deleterious  influence  of  night  air, 
or,  perhaps,  as  is  presumed  by  Copland,  to  the  state  of  the  female 
constitution  during  the  period  of  uterine  activity,  is  doubtless  true ; 
but  it  is  equally  certain,  that,  after  making  every  possible  allowance 
for  the  efficiency  of  these  causes  of  resistance,  we  still  find  enough 
to  convince  us  that  females  are  far  less  obnoxious  to  the  impression 
of  the  febrile  poison  than  individuals  of  the  other  sex.  Speaking 
of  paludal  fevers  generally,  Dr.  Williams  remarks  that  in  the  West 
Indies,  in  civil  life,  a  woman  is  esteemed  twice  as  good  a  life  as  a 
man,  and  he  adds  that  "  in  barracks  the  same  difference  of  liability 
is  observed  between  the  sexes."1  The  same  fact  is  pointed  out  by 
other  writers  in  reference  to  all  those  fevers  conjointly,2  as  well  as 
by  those  who  have  described  the  ordinary  forms  of  the  disease — 
intermittents  and  remittents — in  France,  Africa,  Germany,  and  Italy.3 
In  1,036  cases  reported  by  Dr.  Boling,  of  Alabama,  there  were  585 
males  and  451  females.4 

In  yellow  fever,  the  difference  of  liability  and  intensity  has  been 
noticed  both  in  intra  and  extra  tropical  climates.  In  the  West 

1  Morbid  Poisons,  ii.  456. 

2  Pinkard,  ii.  470;   Hume,  237;  Arnold,  34;  Williams,  51 ;  Henderson.  4;  Madrid, 
pt.  i.  32;  Copland,  iii.  139. 

3  Ramel  de  1'irifluence  des  marais  sur  la  Sante  de  1'homme,  Marseilles  ;  Foder^,  on 
Epidemics;   Hufeland,  Journal  der  prakt,  June,   1811;  Eisenrnann,  Der  Vegetation 
and  Exlanger,  1835. 

Ramel  remarks:  "  Women  are  much  less  subject  to  the  disorders  of  marshy 
localities.  We  have  noticed  this  fact  on  the  coasts  of  Africa,  and  several  of  our 
friends  who  resided  at  Cayenne,  have  assured  us  that  in  that  colony  more  than  one 
female  has  had  six  husbands." 

4  Tr.  Am.  Med.  Assoc.  v.  425. 


420  PNEUMONIA   AND 

Indies  it  was  observed  and  is  dwelled  upon  by  Desportes,1  Moseley,3 
Le blond,3  Blane,4  Pugnet,5  Poissoniere,6  Bally,7  Savaresi,8  Jackson,9 
Hunter,10  Trotter,11  Ilumboldt,12  Caillot,13  Dariste,14  Dickinson.15 

In  this  country,  the  same  circumstances  have  been  recorded  by 
Deveze,16  Kush,17  Carey,18  Bamwell,19  Condie  and  Folwell,20  Cald- 
well,21  Valentin,22  Drysdale,23  A.  Hosack,24  Thomas,25  Townsend,26 
Simons,27  Waring,28  Hogg,29  Cartwright,30  Perlee,31  Merrill,32  Archer,33 
Gros,34  Kept,  of  1ST.  0.  Fever  of  1'819,35  ib.  of  1839,36  Bartlett.37 

In  Europe,  also,  similar  observations  have  been  made  by  Arejula,38 
Berthe,39  Fellowes,40  Louis,41  Bally,42  Gillkrest,43  Caisergue,44  Pal- 
loni.45 

I  am  not  aware  that  the  facts  hitherto  published,  regarding  the 
susceptibility  of  the  sexes  to  typhoid  fever,  are  as  yet  sufficiently 
numerous  to  warrant  us  in  drawing  any  certain  conclusions  from 
them.  In  some  of  the  hospitals  and  cities  of  Europe  and  this 
country,  more  females  than  males  affected  with  this  disease  have 
doubtless  been  treated ;  but,  neither  from  this  circumstance,  nor  from 
anything  as  yet  adduced,  can  we  derive  satisfactory  evidence  of 
the  male  sex  being  less  liable  than  the  female;  for  the  reverse  of 

I  Mai.  do  St.  Domingue,  i.  4,  195.  2  Trop.  Climates,  433. 
3  Fievre  Jaune,  95.                                          4  Dis.  of  Seamen,  405. 

5  F.  cle  Mauvais  Caractere,  347.  6  Mai.  des  Pays  Chauds,  55. 

7  Typhus  d'Amerique,  209,  299.  8  Tr.  de  la  F.  J.  264. 

9  Fev.  of  Jamaica,  250.  I0  Dis.  of  Army  in  Jamaica,  201. 

II  Medica  Nautica,  i.  347.  12  Nouvelle  Espagnc,  775. 

18  Ficvre  Jaune,  15,  135.  H  Fievre  Jaune,  218. 
15  Inflam.  Endem.  of  W.  I.  13,  82.  16  Tr.  de  la  F.  J.  105. 
17  Works,  iii.  80.  I8  Fev.  of  1793,  p.  74. 

19  Physical  Investigations  and  Deductions  from  Med.  and  Surg.  Facts,  374. 

20  Fev.  of  1798,  p.  5.  21  Fev.  of  1805,  p.  78. 

22  Tr.  de  ia  F.  J.  70.  23  Med.  Mus.  i.  33. 

21  Diss.  on  Y.  F.  of  N.  York  in  1795,  p.  2.     B  Tr.  de  la  F.  J.  p.  73. 

25  Fev.  of  N.  Y.  in  1822,  p.  253.  *  Kept,  to  B.  of  H.  of  Charleston,  7,  14. 

23  Fever  of  Savannah,  GO.  »  Western  J.  i.  413. 

30  Med.  Recorder,  ix.  1G.  31  Philad.  J.  of  Med.  and  Phys.  Sc.  i.  10. 

*2  Phila.  J.  of  Med.  andPhy.  Sc.  ix.  24G.     ™  Med.  Recorder,  v.  Cl. 

34  Rap.  sur  la  F.  J.  de  la  N.  0.  in  1817,  p.  7. 

*>  Hid.  in  1819,  p.  7.  36  Ibid,  in  1839,  p.  324. 

37  On  Fevers,  457. 

38  Breva  Dcscripcion  de  la  Fiebre  Amarilla,  182,  438. 

*9  Fievre  J.  d'Andalousie,  354.  «  On  Pestilential  Fever,  120. 

41  On  Yellow  Fever,  291.  42  Typhus  d'Amerique,  301. 

•»  Cycl.  of  Pract,  Med.  ii.  279.  4t  Contagion  de  la  F.  J.  190. 
45  Osservazioni  sulla  Malattia,  &c.  90. 


AUTUMNAL    FEVERS.  421 

the  above  result  sometimes  occurs.  When  it  does  not,  the  greater 
amount  of  females  affected  finds  a  ready  explanation  in  the  excess  of 
female  population  in  some  of  the  cities  where  the  observation  was 
made,  and  the  greater  exposure  of  women  to  the  infection  in  the 
capacity  of  nurses  and  attendants.  But,  however  this  may  be,  it 
has  been  proved  satisfactorily  by  the  statistics  of  every  large  hospi 
tal,  and  by  the  bills  of  mortality  of  some  cities  where  a  proper 
registration  is  kept,  that  as  large  a  percentage  of  male  as  of  female 
patients  die  of  the  disease.1 

The  following  are  the  proportions  which  occurred  in  the  epidemic 
at  Gibraltar  in  1828,  among  the  civilians: — 

Men 684 

Women  .         .         .         .286 

Children          ....     200 

Difference  of  susceptibility  of  the  two  diseases  at  different  periods  of 
life. — Experience  has  shown  that,  with  the  exception  of  a  few  epi 
demics  in  which  children  appear  to  have  suffered  severely  from 
autumnal  and  periodic  fevers,  these  diseases  are  the  attendants  of 
adult  age — the  young  and  very  old  being  comparatively  little  ame 
nable  to  the  influence  of  the  poison,  and,  when  attacked,  having  the 
disease  in  a  milder  form.  Exceptions  to  this  rule  are  to  be  found 
in  those  seasons  when  the  infectious  effluvia  are  concentrated,  and 
unusually  powerful;  or  when  exposure  to  their  influence  is  un 
usually  great.  As  was  mentioned  in  speaking  of  the  comparative 
liability  of  the  sexes,  this  ordinary  exemption  of  the  young  and  old 
may,  in  some  measure,  be  accounted  for  by  their  less  exposure  to 
the  action  of  the  efficient  cause.  t  Nevertheless,  a  review  of  all  the 
facts  we  possess  on  the  subject,  can  leave  no  doubt  on  the  mind  as 
to  a  greater  liability  to  infection  in  adults  and  individuals  in  the 
prime  of  life,  than  at  any  other  period,  as  well  as  to  the  fact,  that  if 
during  the  course  of  some  epidemics,  or  at  the  close  of  others,  a 
larger  proportion  of  children  suffer,  the  result,  on  the  one  hand, 
must  be  ascribed  to  the  fact  that  the  adult  portion  of  those  exposed 
are  acclimatized2 — an  advantage  which  children  do  not  enjoy;  and, 
on  the  other  hand  (as  illustrated  at  Barcelona  in  1821),  to  the  cir- 

1  See  Davidson  on  the  Cause  of  Fever,  60,  61 :  Bartlett,  101. 

2  Catel,  10:   Byam  in  Chisholm,  i.  143;  Arnold,  147;   Statistics  of  British  Army, 
52;  Ramsay,  Hist,  of  S.  C.  ii.  85;   Dickson,  Phil.  J.  iii.  257;   Ib.  Eclectic  J.  iv.  112; 
Simons,  11. 


422  PNEUMONIA    AND 

cumstance,  that  the  proportion  of  this  class  remaining  unattacked 
or  liable  to  be  infected1  was,  owing  to  peculiar  causes,  greatly  en 
larged.  Be  this  as  it  may,  if  we  lay  aside  these  apparently  excep 
tional  cases,  and  examine  the  accounts  of  those  fevers  as  they 
prevail  in  tropical  and  extra-tropical  regions  generally,  we  shall 
find,  that  though  children  and  old  people  are  often  attacked  every 
where,  they  enjoy,  to  a  very  great  extent,  the  exemption  to  which 
I  have  alluded.  So  it  has  ever  proved  in  the  West  Indies,  in 
Europe,  and  in  this  country,  as  we  learn  from  numerous  and  re 
liable  authorities.2 

In  a  memoir  on  the  influence  of  marshes  on  the  duration  of 
human  life,  Yillerme,  in  drawing  his  conclusions  from  a  very  large 
number  of  observations  collected  in  the  paludal  departments  of 
France,  states  that  the  injurious  influence  is  principally  felt  by 
young  children.  He  adds:  1st.  Infants  under  one  year  of  age  ap 
pear,  relatively  to  their  number,  to  suffer  less  than  children  from 
one  to  four.  2d.  After  the  age  of  ten,  the  influence  of  marshes  is 
less  injuriously  felt  than  before.  3d.  It  is,  or  appears  to  be,  still 
less  felt  from  fifteen  and  eighteen,  to  twenty-five;  but,  from  thirty- 
five  or  forty  to  fifty  or  fifty-five,  this  injurious  influence  is  more 
striking,  though  not  as  great  as  among  young  children.  4th.  Fi 
nally,  old  people  appear  more  able  to  resist  the  effects  of  the  mor 
bific  influence  in  question,  than  individuals  at  any  other  periods  of 
life.3 

This,  so  far  as  concerns  children,  is  somewhat  at  variance  with 
what  was  said  above;  but  it  should  be  borne  in  mind  that  the 
amount  of  mortality  among  these  is  not  to  be  understood  as  result 
ing  from  marsh  fevers  alone ;  but  evidently  includes  that  of  children 

1  Copland,  iii.  168. 

2  Chisholm,  i.  141;  Pugnet,  348;   Savaresi,  264,  265;   Caillot,  15,  136;   Moscley, 
438;  Bally,  269-296 ;   II.  McLean,  36 ;   Manson,  6;   Madrid,  32;   Dariste,  218;  Ar 
nold,  34;  Rochoux,  120;  Pinkard,  ii.  476;  Hume,   238;  Williams,    51;   Dickinson, 
13;    Blair,  50;    J.    Clarke,    2;    Arejula,    182;    Sir   James  Fellowes,   58,   420;    Ch. 
Maclean,  15;  Berthe,  170;  Mem.  of  Acad.  of  Barcelona,  23,  44;  Caisergue,  191; 
Louis,  260;  Burnett,  493;  Pariset,  454;  Palloni,  9,  10;  Cleghorn,  106,  Rush's  ed. : 
Deveze,   106  ;  Caldwell,  78  ;  Carey,   74  ;  Condie  and  Fohvell,  5  ;  Monges,  Matthieu, 
Rousseau  (see  Rept.  of  French  Acad.  28);  Valentin,  90;   Thomas,  73-77;   Harrison, 
136;   Barton,  20;  Gros,  71;  Cartwright,  ix.  16;   Merrill,   9,  246;   Simons,  7,  8,  10; 
Townsend,  253  ;  Shecut,  109;  A.  Hosack,  9  ;  Waring,  60;  Dickson,  Eccl.  J.  iv.  112; 
N.  0.  Fever  of  1820,  p.  7  ;  ib.  1839,  p.  325  ;  Archer,  v.  Rec.  61 ;  Brown,  88  ;  Bartlett, 
344  ;  Perry,  N.  0.  J.  April,  1844;  Wharton,  Am.  J.  July,  1843. 

3  Annales  d' Hygiene,  xi.  345,  346. 


AUTUMNAL   FEVERS.  423 

who  die  from  all  diseases.  2d.  That  in  all  situations, whether  marshy 
or  otherwise,  the  mortality  between  one  and  five,  is  much  greater 
than  at  all  other  periods  of  life.  If  these  circumstances  are  taken 
into  consideration,  it  will  be  perceived  that  the  conclusions  arrived 
at  by  Villerme  may  be  correct,  without  invalidating  the  statement 
made  as  to  the  greater  susceptibility  of  adults  to  malarial  fevers. 
It  is  to  be  remarked,  also,  that  Villerm£  refers  to  the  epidemic  of 
Groningen  in  1826.  On  this  occasion,  however,  the  mortality 
among  children  from  one  to  five,  though  considerable,  and  large  in 
Droportion  to  that  at  some  other  periods  of  life,  was  smaller  than 
among  adults  from  forty  to  fifty,  and  from  sixty  to  sixty-five.  At 
Pautin,  and  other  villages  situate  along  the  course  of  the  canal  of 
Ourcq,  malarial  fevers  prevailed  extensively  in  1810,  1811,  1812, 
and  1813 — at  the  period  of  the  construction  of  that  canal; — but 
children  do  not  appear  to  have  suffered  more  severely  than  others 
(352). 

Typhoid  fever  may  also  be  said  to  be  a  disease  of  adult  age ;  for 
though  children,  and  young  ones  too,  as  well  as  old  people,  are 
sometimes  attacked,  they  are  so  comparatively  seldom;  the  fever 
bearing  with  greater  force  on  individuals  from  eighteen  to  thirty.1 

When,  with  these  facts  before  us,  we  inquire  how  matters  stand 
in  relation  to  pneumonia,  we  discover,  contrary  to  the  stated  opin 
ions  of  Hippocrates,  and,  long  after  him,  of  Morgagni,  Cullen,  and 
others,  that,  so  far  from  sparing  children,  the  disease  is  of  very 
common  occurrence  among  them.2  The  researches  of  our  country 
man,  Dr.  Gerhard,3  of  Dr.  Eufz,4  and  other  modern  pathologists,  have, 
it  is  true,  led  to  the  conclusion  that  primitive  pneumonia  seldom  or 
never  attacks  children  between  the  ages  of  two  to  five ;  but  grant 
ing  this  to  be  confirmed  by  subsequent  and  equally  accurate  ob 
servation,  which,  seeing  the  result  obtained  by  Barthez  and  Rilliet,5 
we  cannot  for  the  present  be  inclined  to  do,  it  is  admitted  that  they 
are  very  liable  to  the  secondary  form  of  the  disease.  At  every 

1  Chomel;  Bartlett,  100;  Cowan,  Vital  Statistics  of  Glasgow,  20;  Geary,  Dublin 
Journ.  of  Med.  Sci.  xii.  98,  99. 

2  Laennec,  i.  547;  Billnrd,  Mai.  des  Nouv.  nes,  1833;  Valleix,  ii.  256;  Barthez  and 
Rilliet,  Essai,  77;    Guersent,  Diet,  de  Med.  viii.  76;   Chomel,  same  work,  XXY.  160; 
Williams's  Cyclopedia,  iii.  406  ;  Grissolle,  97,  98 ;  Swett,  79. 

3  Am.  Journ.  Aug.  and  Nov.  1834. 

4  Journal  dcs  Connaissances  Med.  Ch.  1834,  p.  101,  &c. 

5  Maladies  des  Enfants,  i.  108;  Ib.  Essai,  76,  77. 


424  PNEUMONIA    AND 

other  period  of  infancy,  the  two  forms,  whether  lobulated  or  dif 
fused,  are  frequently  observed ;  while,  at  all  subsequent  epochs  of 
life,  individuals  are,  in  an  almost  equal  degree,  liable  to  both  forms. 
I  am  aware,  that  by  many  the  disease  is  supposed  to  bear  with  greater 
force  on  individuals  between  the  ages  of  twenty  and  thirty,  a  result 
apparently  confirmed  by  comparative  tables  draAvn  up  in  the  hos 
pitals  of  Paris,  and  more  particularly  by  the  following  one  of  630 
cases  collected  by  Grisolle : — 

11  to  20  years 84 

20  "  30      "              190 

30  "  40  '   "  .        .        .        .        .        .  117 

40  "  50      "             107 

50  "  60      "              84 

60  "  70      "             37 

70  and  above  11 


But  when  it  is  borne  in  mind  that  the  proportion  of  individuals 
between  twenty  and  thirty  is  considerably  larger  than  that  of  any 
other  portion  of  the  population  of  the  place  where  the  above  results 
were  obtained,  and  that  persons  of  that  age  are  usually  more  ex 
posed  than  others  to  the  exciting  causes  of  the  disease,  we  shall 
cease  to  be  influenced  in  our  conclusions  respecting  the  periods  of 
life  most  obnoxious  to  pneumonia,  by  the  large  number  of  cases 
there  reported.  Indeed,  if  we  take  this  into  account,  we  shall  find 
that  the  excess  of  frequency  at  that  age  does  not  reach  beyond  one- 
tenth,  and  that  the  same  may  be  said  of  the  proportion  between 
thirty  and  fifty.  The  number  in  old  age,  compared  with  the 
number  of  persons  who  have  reached  that  period,  is  very  large, 
and  justifies  the  remark  of  Chomel,  that  pneumonia,  far  from  being 
rare  in  old  people,  is  the  most  frequent  disease  to  which  they  are 
liable,  and  withal  the  most  fatal.2  Dr.  Williams  remarks  that, 
from  his  own  observations,  he  is  inclined  to  consider  young  chil 
dren  as  more  frequently  the  subject  of  pneumonia  than  adults.  Of 
fifty -five  cases  attended  by  Dr.  By  am  and  himself  at  a  dispensary 

1  Chomel,  Diet,  de  Med.  xxv.  100  ;  Grisolle,  101 ;  Pclletan,  Mem.  de  1'Acad.  de 
He'd.  viii.  335. 

a  Op.  cit.  101  ;  see  also  Grisolle,  101 ;  Yalleix,  ii.  257;  Trus,  Mem.  de  1'Acad.  viii. 
13;  Horn-man  and  Dechambre,  Archives,  August,  1835. 


AUTUMNAL   FEVEES.  425 

in  the  parish  of  St.  Marylebone,  thirty-two  cases  were  of  the  age  of 
six  years  and  under.1  A  still  higher  authority,  Laennec,2  is  of 
opinion  that  the  two  extremes  of  life  are  the  most  exposed  to  the 
influence  of  the  disease.  Dr.  Swett,  a  distinguished  physician  of 
this  country,  recognizes  the  greater  frequency  and  fatality  of  pneu 
monia  in  infancy  and  old  age  ;3  and  epidemic  pneumonia  has  been 
found  from  the  days  of  Sydenham  to  our  own,  to  be  rife  and  highly 
fatal  among  persons  advanced  in  life. 

Effects  of  the  passions  and  emotions  in  the  two  diseases. — Nicholas 
Massa,  very  many  years  ago,  said:  "Multi  ex  solo  timore  et  irnagi- 
natione  inciderunt  in  febrem  pestilentialem ;"  Pigray  denominates 
panic  "  pabuluni  et  nutrimentum  pestis."  Similar  views  have  been 
entertained  respecting  the  injurious  effects  of  that  and  other  de 
pressing  passions  and  emotions — anxiety,  grief,  and  sorrow,  as  well 
of  anger,  and  other  exciting  ones — as  productive  causes  of  Oriental 
plague,  by  Diemerbroeck,  Chicoyneau,  Rivirius,  Hodges,  Desgenettes, 
Larrey,  Clot-Bey,  and  almost  every  writer  on  that  disease.  Equally 
explicit  on  the  subject  are  Hoffman,  Aretius,  Coelius  Aurelianus, 
Fazio,  Chirac,  Senac,  Falconer,  Crogan,  Home,  Cullen,  and  Huxham, 
so  far  as  regards  pestilential,  typhus,  nervous,  or  petechial  fevers.  In 
our  own  days,  Dr.  E.  Hamilton,  of  Edinburgh,  has  shown  the  influ 
ence  of  panic  in  propagating  contagious  fever,  as  exhibited  in  the 
Magdalen  Asylum  of  that  city,  in  the  spring  of  1821.4 

Lind,  who,  like  Yandermeer  and  others,  had  pointed  out  the 
baneful  effects  of  mental  depressions  in  the  production  of  scurvy 
and  other  camp  and  ship  diseases,  and  the  benefit  arising  from 
cheerful  and  buoyant  spirits,  remarks,  in  respect  to  their  influence 
in  the  production  of  autumnal  fever,  that  it  is  quicker  and  more 
violent  in  hot  and  insalubrious  situations,  than  in  purer  and  cooler 
air.  A  fit  of  passion,  he  affirms,  often  brings  on  an  instantaneous 
attack  of  fever ;  a  violent  fit  of  anger  or  grief  will  immediately  pro 
duce  a  jaundice  or  the  yellow  fever ;  the  sight  of  a  corpse,  or  any 
object  of  horror,  and  even  a  shocking  story  told  to  a  person,  have 
been  often  known,  through  an  impression  of  fear  upon  the  mind,  to 
bring  on  a  delirium,  sometimes  a  violent  vomiting  and  purging, 
which  vomit  carried  off  the  patient  in  twenty -four  hours.  In  an- 

1  Cyclop,  of  Pract,  Med.  iii.  400.  2  Traite  de  1' Auscultation,  i.  547,  548. 

3  Lect,  on  Dis.  of  the  Lungs,  79.  4  Med.-Chirur.  Trans,  of  Edinb.  i.  296. 


426  PNEUMONIA    AND 

other  work  the  same  author  reiterates  the  sentiment,  remarking 
that  it  is  a  received  opinion  that  fear  is  a  cause  of  itself  sufficient 
to  produce,  in  certain  dispositions,  a  bad  or  malignant  fever ;  there 
being  many  instances  in  besieged  towns,  where  no  other  reason 
could  well  be  assigned  for  the  rise  of  malignant  disorders,  than  the 
dejection  of  spirits,  grief,  and  panic  of  the  inhabitants,  occasioned 
by  the  bombardment,  and  the  apprehensions  of  a  violent  death 
from  some  sudden  assault  of  the  enemy.1 

I  am  not  prepared  to  say  from  personal  observation,  nor  have  I 
now  the  leisure  to  examine,  how  far  the  opinion  of  Lind  as  to  the 
great  injury  arising  from  the  action  of  the  passions,  under  the  cir 
cumstances  mentioned,  exclusive  of  some  other  agency,  may  be 
founded.  Especially  am  I  not  prepared  to  admit  on  so  equivocal 
an  authority  as  Lassis2 — who,  not  content  with  discarding  all  idea 
of  contagion,  disbelieves  the  existence  of  infection  also — that  nine- 
tenths  of  the  mortality  attributed  to  yellow  and  other  fevers,  should 
be  ascribed  to  the  effects  of  the  fear  and  panic  under  which  every 
one  labours  to  a  greater  or  less  extent  in  times  of  epidemics.  But 
there  can  be  no  doubt  that  such  affections  of  the  mind,  as  also  most 
others  to  which  we  are  liable,  will  be  found  to  play  an  important 
part  in  the  production  and  aggravation  of  the  diseases  of  hot  cli 
mates,  and  of  the  summer  season  of  temperate  ones,  whether  in 
Hindostan,  in  Africa,  in  the  West  Indies,  in  this  country,  in  Europe, 
or  anywhere  else.  Upon  this  subject  there  can  be  no  mistake. 
Facts  and  statements  in  relation  to  it  will  be  found  recorded  in 
almost  every  publication  extant  on  those  diseases.  In  his  account 
of  the  fever  of  Barbadoes,  in  1817,  Dr.  Ealph  mentions,  in  illustra 
tion  of  the  influence  of  anxiety  of  mind  in  the  development  of  the 
fever,  the  tendency  it  showed  to  affect  different  classes  of  persons. 
"  First  among  the  people  of  the  huts  it  prevailed ;  then  in  the  bar 
racks.  After  we  had  lost  one  officer  by  fever,  several  others  soon 
became  affected ;  and,  in  like  manner,  when  one  of  the  hospital 
attendants  had  died,  others  soon  fell  sick,  grew  alarmed,  and  died." 
"  Un  caractere  ferme,"  is,  he  remarks,  the  best  preservative  from 
fevers  on  all  occasions.  To  this  cause  we  may  attribute,  in  some 
measure,  the  terrible  mortality  of  the  fever  in  Spain,  "  when  fear, 

'   Op.  cit.  149. 

2  Causes  des  Maladies  Epidemiques,  88  ;  ib.  Calamites  resultant  du  Systeme  de  la 
Contagion,  9,  &c. 


AUTUMNAL   FEVEKS.  427 

the  handmaid  of  ignorance,  reigns  triumphant  over  the  minds  of 
the  people."1 

Similar  statements  are  contained  in  the  works  of  Warren,  20, 
25;  Desportes,  i.  24,  96,  ii.  264;  Clarke,  Dis.  of  Long  Voy.  i.  165; 
Hillary,  146;  Hunter,  18;  Lempriere,  ii.  10,  11 ;  Chisholm,  ii.  53  ; 
Pugnet,  335 ;  Amiel,  Johnson  on  Trap.  Cl  270,  271 ;  Chirac,  Mai  Pest. 
i.  186  ;  Berthe,  147 ;  Pariset,  586 ;  Rush,  iii.  49  ;  Currie,  10 ;  Gros,  7, 
8 ;  Moultrie,  26  ;  Deveze,  113 ;  Johnson,  Trop.  Cl  74;  Maillot,  265  ; 
and  of  others,  reference  to  some  of  whom  will  be  found  at  the  bottom 
of  the  page.2  The  same  remarks  are  applicable  to  excess  in  eating, 
drinking,  indulgence  in  the  venereal  act,  exposure  to  the  sun,  &c., 
all  of  which  are  known,  in  times  of  epidemics,  to  be  fruitful  sources 
of  sickness,  and  to  bring  on  an  attack  in  individuals  who  have  been 
exposed  to  the  action  of  malarial  or  other  zymotic  poisons.  "Were 
I,  says  Dr.  Rush,  to  enter  a  city,  and  meet  its  inhabitants,  under 
the  first  impressions  of  terror  and  distress  from  its  appearance,  my 
advice  to  them  would  be  BEWARE,  not  of  contagion,  for  the  yellow 
fever  of  our  country  is  not  contagious,  nor  of  putrid  exhalations, 
where  the  duties  of  humanity  and  consanguinity  require  your 
attendance,  but  beware  of  exciting  causes? 

While  such  is  the  case  with  malarial  fevers  of  various  grades 
and  forms,  it  may  be  doubted  whether  anything  of  the  kind  can  be 
pointed  out  in  regard  to  pneumonia.  There  are  no  cases  on  record, 
so  far  as  I  have  been  able  to  ascertain,  calculated  to  show  that  the 
disease  has  been  brought  on  effectually  by  the  depressing  or  ex 
citing  passions,  as  we  have  just  seen  in  regard  to  fevers ;  and  it 
may  be  presumed  that  the  medical  writer  who  should,  nowadays, 
venture  on  the  assertion,  that  a  large  number  of  patients  had  been 
seized  with  the  disease  in  consequence  of  their  fearing  to  be  so,  of 
their  labouring  under  the  depressing  effect  of  panic,  or  of  their 
experiencing  a  fit  of  anger;  and  that  others,  endowed  with  a  greater 

1  Med.-Chir.  Trans,  of  Edinburgh,  ii.  23,  24. 

2  Caillot,  188;  Savaresi,  228;  Gillespie,  132;  Rochoux,  24,  114;  Rouppe,  293,  296; 
Bally,  360;  Catel,  17,  18;  Rufz,  34;  Osgood,  22;  Dariste,  iv.  23,  39,  63,  64;  Lefort, 
30,  31 ;  R,  Jackson,  Outlines,  249;  Gilbert,  71;  Bancroft,  185;  Ralph,  ii.  63,  64,  77; 
Mouille,  16;   Repey,  16;   Lorrein,  9;   Mabit,  15;  Hume,  236;   Copland,  ii.   10,  53; 
Blin,  21 ;  Audouard,  435;  McWilliams,  105;  Archer,  Med.  Recorder,  v.  66;  Drysdale, 
Med.  Mus.  i.  34;  Tooley,  16;  Barton,  20;  Perlee,  Chapman's  Journ.  i.  ii.  10;  Barn- 
well,  373;   Fever  of  Mobile  in  1819,  in  Jenning's  collection  relative  to  the  fever  of 
Baltimore. 

3  On  the  means  of  preventing,  &c.  autumnal  diseases,  Works,  iv.  126. 


428  PNEUMONIA    AND 

share  of  moral  courage,  equanimity  of  temper,  or  a  fine  flow  of 
spirits,  had  escaped,  would  be  likely  to  excite  the  surprise  of  his 
professional  readers.  Nor  is  it  less  evident,  that,  common  as  pneu 
monia  is  in  certain  regions  and  seasons,  of  all  countries,  our  own 
included,  the  number  of  cases  would  be  vastly  increased,  were 
indulgences  in  good  eating  and  hard  drinking,  and  especially  in 
what  good  old  Floyer  quaintly  denominated  "  womanizing,"  as  cer 
tain  to  bring  on  an  attack  of  that  disease,  as  they  are  to  occasion 
the  development  of  fevers  in  persons  exposed  to  a  malarial  atmo 
sphere. 

It  is  possible  that  as  regards  the  importance  attached  by  me  to 
the  preceding  points,  as  also  to  many  of  those  noticed  on  former 
occasions,  I  may  err;  and  that  for  advocating  them  so  earnestly,  I 
may,  in  the  opinion  of  some  learned  writers,  exhibit  nryself  in  the 
light  of  one  who  has  remained  sadly  behind  the  times.  But,  if  I  am 
really  found  amenable  to  so  grave  a  charge,  I  have  the  consolation 
to  know,  that  those  who  entertain  contrary  views,  and  may  accuse 
me  of  ignorance,  have  not  as  yet  produced  anything  on  the  subject 
calculated  to  establish  the  correctness  of  their  own  position,  and 
likely  to  change  the  current  of  opinion  on  the  question  at  issue 
amongt  the  enlightened  and  reflective  portion  of  medical  inquirers. 
Let  the  reader  examine  what  has  been  written  on  the  subject ;  let 
him  inquire  what  are  the  sentiments  entertained  on  these  various 
points,  in  this  country  and  Europe,  and  he  will  find  in  what  I  have 
said  little  more  than  the  reassertion  of  opinions  more  than  once 
advocated ;  and  of  facts  and  statements  adduced  by  the  very  highest 
professional  authorities.  If  I  err,  therefore,  I  do  so  in  good  com 
pany.  And  surely,  under  these  circumstances,  I  can  have  no  objec 
tion  to  being  accused  of  upholding  antiquated  notions,  of  hazarding 
nothing  but  bare  assumptions,  and  amusing  myself  with  starting 
conjectures  at  variance  with  what  is  fancied  to  be  the  present  state 
of  knowledge ;  provided,  not  that  my  opponents  should  prove  that 
they  are  right  and  I  am  wrong,  for  this  might  give  them  some 
trouble ;  but  that  the  aforesaid  authorities,  to  whom  the  medical 
world  has  heretofore  found  good  reason  to  look  up  to  as  safe 
guides,  should  be  regarded  as  open  to  the  same  sort  of  censure. 

TJie  prevalence  of  the  two  diseases  at  the  same  time  and  in  rapid  succes 
sion  no  proof  of  identity. — We  have  seen  that  those  who  advocate  the 
idea  of  the  unity  of  pneumonia  with  periodic  fever,  derive  an  argu- 


AUTUMNAL   FEVERS.  429 

ment  in  favour  of  their  views  from  the  circumstance  that  these 
diseases  sometimes,  or  indeed,  often  prevail  at  the  same  time  in  the 
same  place,  or  in  neighbouring  localities,  or  that  they  succeed  to  one 
another  in  the  same  situation,  merging  into  each  other  as  time  pro 
gresses.  If,  as  it  is  argued,  intermittent,  remittent,  and  other  fevers, 
arising  indubitably  from  the  action  of  malarial  exhalations,  and  if,  as 
every  pathologist  acknowledges,  these  fevers  are  identical  in  nature 
— different  forms  of  one  and  the  same  complaint — if  they  prevail 
together,  or  replace  each  other  as  the  season  advances ;  and,  if  from 
this  circumstance  of  coexistence  and  succession  we  are  justified  in 
inferring  the  existence  of  a  similarity  of  origin  and  of  nature,  so 
the  coexistence  of  pneumonia  with  those  fevers,  and  the  succession 
of  the  former  to  the  latter,  must  equally  warrant  the  conclusion 
that  they  arise  from  the  same  cause,  and  constitute  different  forms 
of  the  same  disease;  "  the  difference  in  their  characters — phenomenal 
and  anatomical — arising  in  part  from  the  season  of  the  year  in 
which  they  appear,  the  peculiar  localities  in  which  they  occur,  but 
mainly  from  the  nature  of  the  organs  which  become  involved  in 
the  diseased  action,  the  predominance  of  inflammation  or  conges 
tion,  and  the  character  of  their  periodicity."  Dr.  Merrill,  who  seems 
to  attach  much  importance  to  the  circumstance  of  succession,  and 
doubtless  will  not  refuse  to  join  in  sentiment  with  those  who  appeal 
to  that  of  coexistence,  sums  up,  in  a  passage  already  cited,  but 
which  I  must  once  more  call  attention  to,  the  gradual  changes 
which  this  supposed  one  and  identical  disease  experiences  as  time 
advances.  "  In  the  spring,  we  are  apt  to  find  those  diseases  assum 
ing  names  which  have  reference  more  particularly  to  this  periodi 
city  and  general  pathology.  As  summer  comes  on,  the  greater 
implication  of  the  hepatic  organs  changes  the  name,  or  adds  an 
epithet  to  designate  a  prominent  symptom.  In  autumn,  the  chylo- 
poietic  viscera  become  more  strikingly  involved  in  the  diseased 
action ;  and  this,  again,  is  indicated  by  an  ever-changing  nomen 
clature.  But  when  winter  approaches,  and  the  subjects  are  exposed 
to  sudden  transitions  of  temperature,  the  thoracic  viscera  are  called 
upon  to  bear  the  burden  of  local  disease ;  and  then  it  is  that  the 
names  pleurisy,  pneumonia,  pneumonia  typhoides,  pneumonia  bi- 
liosa,  pleuro-pneumonia,  bilious  pleurisy,  lung  fever,  &c.  become 
familiar  sounds." 

The  attempt  made  to  prove  the  identity  of  the  diseases  in  ques 
tion  on  the  ground  of  their  coexistence  and  succession,  differs  in 


430  PNEUMONIA    AND 

nothing  from  that  made  to  assimilate  together,  both  as  regards 
causation  and  nature,  certain  forms  of  febrile  diseases,  which,  by 
other  -observers,  are  viewed  as  totally  distinct  from  each  other,  and 
also  by  that  which  has  not  unfrequently  been  attempted,  to  deprive 
them  all  of  an  independent  nosological  position,  and  pathological  in 
dividuality,  and  prove  them  to  be  nothing  more  than  so  many  grades 
or  forms  of  common  autumnal  malarial  fever.  But  the  argument 
founded  on  such  occurrences  is  not  more  satisfactory  in  the  one  case 
than  in  the  other.  Were  it  valid,  we  should  on  the  same  ground  be 
led  to  the  conclusion  that  scarlatina,  measles,  hooping-cough,  influ 
enza,  and  the  like,  which  sometimes  coexist  with  or  succeed  to  each 
other,  are  one  and  all  offsprings  of  the  same  parent,  and  necessarily 
one  and  the  same  disease.  We  should  be  compelled  to  admit 
also  that,  inasmuch  as  measles  or  influenza  are  followed  occa 
sionally  by  angina,  in  some  of  its  various  forms,  and  often  coexist 
with,  and  more  frequently — though  not  universally,  as  maintained 
by  Webster — precede  autumnal  or  periodic  fever,  whether  these 
present  themselves  in  the  endemic  or  epidemic  garb,  it  necessa 
rily  follows  that  they  must  all  be  viewed  as  resulting  from  the  same 
cause  as  such  fevers,  and  as  being  mere  modified  forms  of  them — 
the  difference  depending,  as  in  the  case  of  pneumonia,  upon  the 
season  of  the  year  at  which  they  make  their  appearance,  the  locali 
ties  in  which  they  may  occur,  or  the  organs  and  tissues  which 
become  involved,  &c.  We  every  day  see  other  coexistences  and 
successions  of  djseases  which  have  nothing  in  common  with  each 
other  in  respect  to  pathology  and  etiology ;  and  which  are  equally 
independent,  on  those  points,  of  the  ordinary  autumnal  or  periodic 
fevers  of  the  localities  where  they  show  themselves.  Asiatic 
cholera,  for  example,  must  have  preceded,  succeeded  to,  and  coex 
isted  with,  many  a  prevalence  of  such  fevers,  and  in  1832  it  existed 
simultaneously,  in  New  Orleans,  with  the  yellow  fever ;  and  yet  no 
writer  of  note,  save  Dr.  Merrill,  Dr.  Searle,  and  a  few  others,  have 
ever  seriously  thought  of  holding  up  cholera  as  a  mere  form  of 
autumnal  fever — a  disease  which  it  no  more  resembles  in  respect  to 
phenomenal  and  anatomical  characters,  mode  of  progression,  and 
laws  by  which  it  is  governed,  than  smallpox  does  scarlet  fever.  If 
it  approximates  it  on  any  point,  it  is  in  appearing  with  greater 
force  in  localities  noted  for  containing  sources  of  malarial  infection; 
a  circumstance  for  which  it  has  been  supposed  by  some  physicians 
of  reputation  in  Europe,  as  Boudin,  Marechal,  Moucbet,  and  others, 


AUTUMNAL    FEVERS.  431 

and  a  few — but  very  few — of  equal  stamp  in  this  country,  to  belong 
to  the  category  of  malarial  diseases.  But  on  closer  and  more  care 
ful  examination,  we  shall  find  reason  to  discard  such  notions,  and 
to  conclude  that,  in  the  case  of  cholera,  as  in  that  of  other  zymotic 
diseases  which  have  nothing  in  common  with  autumnal  fevers 
except  their  toxical  origin,  the  effluvia  arising  from  these  foul 
localities,  as  well  as  putrescent  food,  impure  water,  &c.,  produce 
their  deleterious  effects,  not  by  furnishing  the  efficient  cause  of  the 
disease,  but  by  predisposing  the  system  of  those  exposed  to  their 
influence,  to  receive  the  morbid  impress  of  that  cause.  Typhoid 
pneumonia,  which  some  have,  with  equal  impropriety,  converted 
into  a  peculiar  form  of  periodic  fever,  but  which,  from  its  symp 
toms,  the  season  of  the  year  at  which  it  usually  shows  itself,  and 
the  places  where  it  has  at  times  reigned  paramount,  is  evidently 
unconnected  with  this  disease,  has  necessarily  been  found  in  some 
localities  to  succeed  the  latter,  and  may,  so  far  as  I  now  recollect, 
have  prevailed  simultaneoiisly  with  it.  Nevertheless,  few  patholo- 
gists  will  feel  disposed,  from  this  circumstance  alone,  to  coincide 
with  them  in  the  views  they  have  set  forth  as  regards  the  nature 
of  that  complaint.  All  who  have  seen  much  of  it,  recognize  it  to 
proceed  from  a  special  epidemic  cause,  similar  everywhere,  and 
giving  rise  to  phenomena  which  impart  to  it  a  character  distinct 
from  that  of  autumnal  fevers.  It  requires  no  great  stretch  of 
diagnostic  knowledge  to  perceive  that  it  is  nothing  but  a  combi 
nation  of  pneumonia  and  typhus  or  typhoid  fever.  It  reigned  in 
this  country  from  1807  to  1820— principally  from  1812  to  1814. 
During  this  period,  typhus  or  typhoid  fevers  occurred  extensively, 
while  the  pneumonia  was  superadded  in  some  cases  only. 

Typhus,  typhoid,  and  relapsing  fevers  have  been  found  to  pre 
vail  together  in  several  cities  and  localities  of  Great  Britain.  In 
this  country,  typhus,  and  especially  typhoid — the  more  common 
disease  of  the  two  on  this  side  of  the  Atlantic — have  not  unfre- 
quently  coexisted,  to  a  certain  extent  at  least.  More  often  they 
have  succeeded  to,  or  supplanted  the  common  autumnal  or  periodic 
fever ;  and  yet  the  soundest  pathologists  and  most  experienced  and 
careful  observers  of  the  day — men  whom  the  stiffest  contemner  of 
book  authorities  may  not  be  ashamed  to  look  up  to  with  respect — 
have  found  ample  cause  to  regard  these  two  fevers,  however  true  it 
may  be  they  both  belong  to  the  class  of  zymotics,  as  distinct  diseases; 
while  the  physician  who,  in  this  nineteenth  century,  should  argue 


432  PNEUMONIA    AND 

from  the  fact  of  typhoid  fever  prevailing  at  the  same  time  with,  or 
succeeding  to,  or  supplanting  ordinary  autumnal  fevers ;  that  it  is 
merely  a  modified  form  of  the  latter  disease,  thus  ignoring  the  fact 
that  the  former  presents  distinct  phenomena,  and  gives  rise  to  dis 
tinct  anatomical  characters;  that  it  runs  a  different  course;  that  it 
has  a  different  duration,  and  appears  often  in  places  where  malarial 
fevers  have  never  shown  themselves,  or  have  ceased  to  appear,  or 
at  seasons  of  the  year  when  malaria  is  not  and  cannot  be  evolved; 
that  it  is  in  all  probability  antagonistic  of  the  other,  and  is  propa 
gated  in  a  different  way — would  give  no  enviable  measure  of  his 
professional  sagacity  and  knowledge. 

Admit,  then,  for  a  moment,  the  validity  of  an  argument  in  sup 
port  of  the  identity  of  pneumonia  with  autumnal  fevers  founded  on 
the  coexistence  of  the  two  diseases  in  the  same  locality,  or  the  suc 
cession  of  the  former  to  the  latter,  and  the  reverse,  and  we  shall  be 
forced,  for  the  sake  of  consistency,  to  make  other  and  kindred 
admissions,  which,  in  the  present  state  of  knowledge,  would  appear 
rather  awkward.  That  typhoid  fever  is  not  a  mere  form  of  common 
periodic  fever,  is  a  pathological  fact,  which,  from  what  precedes,  I 
take  for  granted  every  intelligent  and  well-informed  physician 
knows  full  well.  The  typhoid  is  the  predominant  fever  of  a  great 
portion  of  our  Eastern  States,  and  of  many  districts  of  France,  and 
other  localities  where  periodic  fevers  are  not  at  all  known  or  sel 
dom  encountered.  Paris,  London,  and  other  cities,  as  we  have  seen, 
are  not  visited  by  intermittent  and  remittent  fevers — while  typhoid 
fever  prevails  there  extensively.  Now,  if  we  regard  the  pneumonia, 
which  in  malarial  districts  occurs  at  the  same  time  with  or  follows 
on  the  heels  of,  intermittent  and  remittent  fever,  as  identical  with 
them,  on  the  ground  of  that  coexistence  or  succession,  there  is  no 
reason  why  we  should  not  admit  that  cases  of  pneumonia,  which 
are  very  common  in  New  England,  in  Paris,  London,  and  other 
places  subject  to  typhoid  fever,  and  which  coexist  with  or  follow 
that  complaint,  are  due  to  the  same  cause  that  gave  rise  to  the 
latter,  and  are  mere  modifications  of  it.  The  conclusion  would  not 
be  more  extraordinary  in  the  latter  than  in  the  former  case. 

But  there  can  be  no  necessity  to  enlarge  on  this  matter.  Already, 
in  the  opening  chapter,  attention  was  partially  called  to  it,  and 
enough  was  perhaps  then  said  to  justify  the  inference,  that  nothing 
favourable  to  the  idea  of  the  identity  of  pneumonia  with  periodic 
fevers  could  be  made  out  of  the  fact  that  the  two  diseases  coexist, 


AUTUMNAL   FEVERS.  433 

or  that  the  former  succeeds  to  the  latter.     It  was  there  remarked 
that  inflammation  of  the  lungs  prevails  very  extensively  in  places 
where  remittent,  intermittent,  and  other  fevers  of  kindred  nature 
are  not  observed  ;  that  it  shows  itself  usually  at  seasons  of  the  year 
when,  if  the  ordinary  causes  of  fever  had  at  any  time  exercised 
their  influence,  they  have  been  effectually  or  temporarily  removed ; 
that  in  places  where  periodic  fevers  prevail  daring  a  certain  period 
of  the  year,  they  are  put  a  stop  to,  in  all  their  varieties,  by  frost. 
It  was  shown  that  while  fevers  are  thus  arrested,  pneumonia,  which 
had  coexisted  with  them,  instead  of  disappearing  also,  continues  to 
prevail  as  it  did  before  the  accession  of  frost,  or  even  is  observed  to 
spread  more  extensively;  and  that  as  the  cause  of  the  fever  had  thus 
been  destroyed — as  proved  by  the  entire  absence  of  its  legitimate 
effects — the  cases  of  pneumonia  which  continue  to  show  themselves 
after  the  accession  of  frost,  cannot  be  referred  to  the  morbid  agency 
of  the  cause  in  question,  but  are  due  to  the  operation  of  some  other 
morbific  influence,  over  which  frost  exercises  no  control,  and  differ 
ing  consequently  from  the  former.     It  was  stated  that  the  same 
causes  which  give  rise  to  pneumonia  after  a  stop  has  been  put  to 
periodic  fevers  by  frost,  must  be  similar  to  those  that  produce  the 
disease  during  the  prevalence  of  those  fevers  and  anteriorly  to  the 
occurrence  of  frost.     It  was  moreover  argued  that,  if  the  cause 
which   produces  pneumonia  after  that  event    must,   for   reasons 
stated,  differ   essentially  from   that   occasioning  the   fevers   thus 
arrested  in  their  course,  the  cause  giving  rise  to  the  cases  that  ap 
pear  during  the  fever  season,  must  also  be  different  from  the  febrile 
poison;   that  hence,  when  the  two  diseases  show  themselves  to 
gether,  two  sets  of  causes  are  at  work;  that  from  this  difference  of 
cause  we  have  reason  to  infer  the  existence  of  a  difference  in  the 
nature  of  the  diseases  produced ;  and  that  when  pneumonia,  in  the 
regular  succession  of  the  seasons  follows  on  periodic  fevers,  after  the 
accession  of  cold  or  frost,  or  at  the  period  of  atmospheric  vicissi 
tudes,  it  is  not  influenced  in  its  production  by  the  cause  of  those 
fevers.     It  appears,  therefore,  as  the  effect  not  of  a  gradual  change 
from  one  form  to  another  of  the  same  complaint,  but  as  the  result 
of  the  creation  of  a  different,  or  the  continuance  of  an  independent 
disease. 

Pneumonia  and  autumnal  fevers  are  not  convertible  diseases. — In 
order  that  coexistence  and  succession  may  furnish  material  towards 
28 


434  PNEUMOXIA    AND 

building  an  argument  in  favour  of  the  identity  of 'the  two  diseases, 
it  is  necessary  that  they  should  be  combined  with  other  concomi 
tant  circumstances.  Separately  considered,  they  can  serve  but  little 
purpose,  and  lend  but  feeble  aid  in  the  settlement  of  the  question. 
The  connection  of  intermittents  with  remittents,  which  has  been 
appealed  to,  in  illustration  of  the  supposed  identity  under  examina 
tion  ,  affords  but  little  support  to  the  argument,  because  it  is  founded 
to  a  much  greater  extent  on  other  and  more  weighty  facts  than 
mere  coincidence  and  succession.  Under  much  variety  of  aspect, 
as  is  remarked  by  a  most  eminent  writer  of  this  country,  these 
fevers  "possess  many  deep-seated  analogies  and  identities;  they  fre 
quently  change  from  one  type  to  the  other.  Thus,  an  intermittent 
turns  into  a  remittent,  and  the  latter,  assuming  the  type  of  the  for 
mer,  is  often  seen  to  become,  first  a  quotidian,  then  a  tertian,  and 
finally,  a  quartan.  A  simple  intermittent  may,  in  the  third  or 
fourth  paroxysm,  take  on  the  character  of  a  fatal  congestion;  and 
that  which  began  with  an  aspect  of  malignity,  sometimes  emerges 
into  simplicity  and  mildness;  vernal  agues  attack  those  who,  in 
autumn,  had  suffered  under  remittent  fever,  not  less  than  those  who 
had  experienced  the  intermittent  form ;  the  sequelas  of  all  the  varie 
ties  are  almost  identical;  the  same  treatment,  with  certain  modifica 
tions,  is  applicable  to  the  whole."  Surely,  nothing  of  this  kind  is 
observed  to  occur  in  reference  to  many  diseases,  the  identity  of 
which  is  insisted  upon  on  the  ground  that  they  coexist  together, 
or  follow  each  other  in  the  same  locality.  The  yellow  and  common 
autumnal  fevers,  though  kindred  zymotic  diseases,  and  arising  from 
malarial  exhalations,  are  not,  strictly  speaking,  convertible,  though 
cases  occur  which  exhibit  symptoms  characteristic  of  both,  and  the 
diseases  may  either  blend  together,  or  appear  in  rapid  succession 
in  the  same  subject.  Kemittents  or  intermittents  never  change 
into  yellow  fever,  and  vice  versa ;  their  anatomical  characters  and 
sequels  are  not  the  same;  those  attacked  with  yellow  fever  in  the 
autumn,  are  not  affected  with  ague  the  following  spring,  and  the  as 
pect  of  the  two  diseases  are  not  the  same.  In  a  word,  they  do  not 
possess  deep-seated  analogies  and  identities  similar  to  those  existing 
between  the  various  forms  of  ordinary  paludal  fevers.  Still  less 
allied  to  autumnal  fevers  in  those  respects,  are  typhoid  or  typhus 
fevers,  and  true  oriental  plague,  which,  under  the  fostering  hands  of 
some  Unitarian  pathologists,  have  been  admitted  into  the  family  of 

1  Drake,  704. 


AUTUMNAL    FEVERS.  435 

periodic  marsh  miasmatic  fevers,  there  to  keep  company  with  yellow 
fever,  Asiatic  cholera,  typhoid  pneumonia,  to  say  nothing  of  phre- 
nitis,  gastritis,  gastro-enteritis,  hepatitis,  and,  for  what  I  know,  peri 
tonitis,  cystitis,  tonsillitis,  nephritis,  gout,  rheumatism,  and  the  rest 
of  the  forty  or  fifty  different  varieties  of  diseases  into  which,  as  we 
are  told,  the  nosology  of  southern  fevers  might  be  arranged,  and 
which  constitute  so  many  links  in  the  chain  of  morbid  action,  ex 
tending  from  a  septenary  ague  up  to  the  most  violent  and  fatal  form 
of  yellow  fever.  At  a  still  greater  distance,  in  these  same  respects, 
from  autumnal  fevers,  do  we  find  pneumonia.  So  far  as  I  am  aware, 
the  physician  is  yet  to  be  found  who  has  discovered  that  pneumonia 
and  periodic  fevers  are  convertible  diseases  in  the  way  that  the  seve 
ral  forms  of  these  have  been  shown  to  be.  A  case  of  intermittent  or 
remittent  is  not  converted  into  pneumonia  by  injudicious  treatment, 
or  a  case  of  pneumonia  transformed  into  a  mild  intermittent  by 
proper,  or  into  malignant  remittent  by  improper  remedies;  their 
sequelae  are  not  identical.  Those  who  have  pneumonia  in  the  autumn 
or  winter,  do  not  run  as  much  risk  of  suffering  from  vernal  agues 
or  summer  remittents,  as  those  who  have  passed  through  these  com 
plaints;  they  do  not  possess  many  deep-seated  analogies  and  iden 
tities,  and  the  same  treatment  would  require  more  than  trifling  modi 
fications  to  make  it  applicable  to  both. 

In  saying  this  much  on  the  subject,  I  am  far  from  denying  the 
change  from  one  disease  to  another.  Such  changes  are  of  daily 
occurrence,  and  are  observed  in  regard  to  almost  every  complaint 
to  which  the  human  system  is  subject.  A  case  commences  with 
symptoms  of  common  remittent  or  intermittent  fever,  and  at  its 
close  exhibits  phenomena  appertaining  to  yellow  fever.  In  other 
instances  the  reverse  occurs,  cases  of  yellow  fever  ending  with 
symptoms  of  periodic  fever.  Typhus,  typhoid,  or  pestilential  fevers 
terminate  sometimes  in  the  same  way ;  while,  at  other  times,  cases 
which  at  their  outset  presented  the  characteristics  of  common  inter 
mittent  or  remittent  fever,  assume,  as  the  disease  progresses,  those 
of  the  fevers  mentioned.  So  also  with  regard  to  pneumonia  and 
fever.  Cases  of  the  former  not  UD frequently,  under  peculiar  ende 
mic  or  epidemic  influences,  end  with  symptoms  of  autumnal,  as  also 
of  yellow,  or  typhus,  or  typhoid  fever.  On  the  other  hand,  cases 
of  periodic  or  other  fevers  sometimes  terminate  with  symptoms  of 
pneumonia. 

Doubtless  changes  of  the  kind  may,  strictly  speaking,  be  re- 


436  PNEUMONIA    AND    AUTUMNAL    FEVERS. 

garded  as  the  effect  of  conversion;  but  the  conversion  herein 
noticed  is  not  that  of  one  form  of  a  disease  into  another  form  of  the 
same.  It  cannot  be  occasioned  by  an  increased  force  in  the  cause 
of  the  disease  first  existing,  by  a  difference  in  the  state  of  predispo 
sition  of  the  person  attacked,  or  by  the  peculiar  mode  of  treatment 
pursued.  It  is  not  the  result  of  a  mere  modification  of  one  and  the 
same  thing ;  but  a  change  of  one  thing  to  another  of  a  more  or  less 
different  kind;  in  a  word,  it  is  the  substitution,  partial  or  complete, 
of  one  disease  for  another.  Such  conversions  of  diseases  are  not  of 
rare  occurrence.  They  are,  indeed,  familiar  to  all  practitioners. 
They  often  lead  to  evil  or  fatal  consequences,  or  simply  to  the 
removal  of  disease  without  restoration  to  health ;  and,  without  feel 
ing  disposed  to  believe,  with  Sir  George  Gibbes,  that  one  disease  is 
always  necessary  to  the  cure  of  another,  that  just  as  many  functions 
undergo  a  secondary  derangement  as  are  necessary  for  the  cure  of 
the  primary  one,  and  that  no  diseases  occur  but  such  as  are  curative 
in  their  effects  or  in  their  tendency,1  we  cannot  doubt,  taught  as 
we  are  by  daily  experience,  that  the  cure  of  one  disease  is  often 
effected  by  the  occurrence  of  another;  but  whether  leading  to 
baneful  or  salutary  consequences,  while  many  conversions  are  due 
to  the  transfer  from  one  part  to  another  of  a  specific  cause,  floating, 
as  it  were,  in  the  system,  as  the  gouty,  rheumatic,  &c.,  a  large  num 
ber  are  the  effects,  not  of  the  operation  of  such  a  cause  acting  in 
this  latter  way,  but,  as  already  stated,  of  the  slow  or  abrupt  substi 
tution  of  one  disease  for  another ;  sometimes,  though  not  necessarily, 
allied  to  it  in  a  pathological  or  etiological  point  of  view. 

The  late  Dr.  Hillier  Parry,2  of  Bath ;  Dr.  Mackenzie,3  and  others, 
relate  interesting  cases  of  the  kind,  and  several  have  fallen  under 
my  own  observation,  embracing  a  variety  of  dissimilar  complaints; 
and  if  such  occurrences  are  admitted  to  take  place  in  the  cases  men 
tioned,  we  can  have  no  reason  to  doubt  that  the  same  will  hold  good 
in  reference  to  those  instances  in  which  symptoms  of  one  fever  re 
place  those  of  another ;  as  also  in  those  in  which  the  phenomena  of 
autumnal  fever  succeed  to  those  of  pneumonia,  and  vice  versa. 

1  Brit,  and  For.  Med.  Rev.  xxiii.  591. 

2  Elements  of  Pathology  and  Therapeutics,  i.  48,  306-320. 

3  Sketch  of  the  Natural  Cure  of  Diseases,  Brit,  and  For.  Med.  Rev.  xxiii.  590. 


CHAPTER  VII. 

PNEUMONIA  AND  AUTUMNAL  FEVEKS,  ALTHOUGH  INDE 
PENDENT  OF  EACH  OTHER,  AS  REGARDS  NATURE  AND 
CAUSE,  COMBINE  TOGETHER,  AND  FORM,  LIKE  OTHER 
COMPLAINTS,  HYBRID  DISEASES,  WHICH  MUST  NOT  BE 
CONSIDERED  AS  PECULIAR  FORMS  OF  EITHER. 

Cases  of  pneumonia  marked  by  symptoms  appertaining  to  autumnal 
fever,  are  the  results  of  complications. — I  am  prepared  to  be  told  that, 
so  far,  my  remarks  can  have  had  reference  only  to  pure  and  idiopa- 
thic  pneumonia,  such  as  the  disease  is  said  to  show  itself  in  high  and 
healthy  localities  and  northern  latitudes,  and  that  they  do  not  apply 
to  that  form  of  it  which  physicians  in  the  south  or  southwest  are 
in  the  habit  of  observing.  I  may  be  told,  that  cases  there  present 
themselves,  in  which  the  ordinary  symptoms  of  pneumonia  are  more 
or  less  modified,  and  are  associated,  to  a  greater  or  less  extent, 
with  other  phenomena  which  approximate  the  disease  to  autumnal 
fevers ;  and  that  while  in  other  regions  thoracic  inflammation  may 
be,  for  what  we  know — for  on  that  matter  doubts  are  occasionally 
expressed — independent  of  periodic  fevers  both  in  regard  to  causa 
tion  and  nature,  the  cases  which  prevail  in  malarial  countries,  and 
exhibit  the  phenomena  in  question,  may  be  admitted  to  give  coun 
tenance  to  the  hypothesis  under  examination.  Of  the  occurrence 
of  such  cases,  no  experienced  or  well-read  physician  can  be  igno 
rant.  He  must  be  fully  aware,  that  in  miasmatic  regions  they  are 
frequently  encountered,  and  that  there  pneumonia — like,  indeed, 
very  many  other  diseases — often,  if  not  generally  assumes,  to  a 
greater  or  less  extent,  the  periodic  type.  So  frequently  are  such 
cases  observed  in  those  regions,  and  so  decided  often  is  the  tendency 
to  this  type,  that  it  cannot  be  a  matter  of  astonishment  that  some 
physicians,  noticing  a  succession  of  instances  of  the  kind,  and  yield 
ing  too  readily  to  a  spirit  of  exaggeration  and  hasty  generalization, 


438  PNEUMONIA    AND 

pardonable  in  individuals  of  limited  professional  acquirements,  but 
which  ought  not  to  be  encountered  in  other  quarters,  should  have 
been  deceived,  and  arrived  at  the  conclusion  that,  with  few  ex 
ceptional  instances,  in  which  they  admit,  on  the  authority  of  others, 
the  disease  to  be  idiopathic,  "the  pneumonia  which  prevails  in  this 
country,  sometimes  sporadically,  and  frequently  as  an  epidemic,  is 
really  and  substantially  nothing  more  than  a  peculiar  form  of 
remittent  and  intermittent  fever." 

But  when  we  view  these  facts  more  attentively,  without  being 
swayed  by  a  favourite  hypothesis,  and  with  a  full  knowledge  of 
the  occurrence  of  kindred  modifications  in  a  number  of  other  dis 
eases,  and  of  the  diversified  effects  produced  in  many  complaints 
by  the  various  modifying  influences  that  surround  us,  we  shall  not 
be  long  in  perceiving,  that  the  facts  in  question  admit  of  an  easy 
explanation,  on  principles  very  different  from  those  contended  for 
by  the  advocates  of  the  identity  in  question,  and  in  a  way  which 
renders  unnecessary  the  disunion  of  the  beforementioned  class  of 
pneumonias  from  the  ordinary  form  of  that  disease.  It  is  a  fact 
well  ascertained,  and  perfectly  familiar  to  those  who  have  investi 
gated  the  subject  of  the  progress  and  succession  of  epidemic  or 
endemic  diseases,  that  the  type  of  the  fever  which  prevails  immedi 
ately  before  the  outbreak  of  pneumonia — in  other  words,  before  the 
period  of  the  year  at  which  the  usual  causes  of  the  latter  are  mostly 
encountered  and  operate  with  more  force  and  effect  on  constitutions 
predisposed  to  their  action  arrives — impresses  its  own  character  on 
pulmonary  inflammations.  Hence  at  that  season,  low  surfaces,  the 
vicinity  of  mill-ponds,  of  the  banks  of  streams,  and  of  other  locali 
ties,  which  before  were  the  abodes  of  pure  remittent  and  intermit 
tent  fevers,  become  the  seat  of  pneumonias,  which  often  assume  a 
marked  remittent,  and  not  unfrequently  an  intermittent1  character — 
the  result  of  anterior  influences ;  while  the  same  disease  in  other  situ 
ations  where  malaria  is  not  evolved,  or  at  a  more  advanced  period  of 
the  year,  when  it  has  been  completely  destroyed,  presents  nothing  of 
the  kind  for  a  longer  period.1  The  same  combination  of  phenomena 
is  necessarily  observed  for  a  longer  period  whenever  pneumonia  shows 
itself  in  localities  where  malaria  continues  to  be  evolved  all  the  year 
round,  or  where,  from  the  absence  of  frost,  it  is  only  moderated,  and 
not  completely  destroyed.  In  many  such  cases  the  inflammation  of 

1  Lewis,  Med.  Topog.  of  Alabama,  N.  0.  J.  iv.  28. 


AUTUMNAL    FEVERS.  439 

the  lungs  presents  itself  in  combination  with  symptoms  appertaining 
to  ordinary  bilious  remittent  fever,  or  hepatic  or  bilious  derange 
ment,  giving  rise  to  what  is  denominated  bilious  pleurisy,  a  form 
of  disease  accurately  described  by  many  American  and  European 
writers.1  In  other  instances,  the  bilious  symptoms  are  not  so  pro 
minent,  and  the  affection  of  the  lungs  is  associated  with  those  of 
simple  remittent  or  intermittent  fevers.2  Indeed,  instances  of  re 
mittent  and  even  intermittent  pneumonia,  pleurisy  and  pulmonary 
catarrh,  in  which  the  inflammation  is  complicated  with  symptoms 
indicating  the  existence  in  greater  or  less  purity  of  the  element  of 
periodicity,  are  to  be  found  described  in  the  writings  of  the  most 
reliable  authors.  Morton,  who  early  called  attention  to  them,  and 
indicated  the  treatment  they  required,  had  seen  a  hundred  such 
cases ;  and  since  his  day  they  have  continued  to  be  adduced  as  ob 
jects  of  familiar  professional  observation,  not  only  in  Europe,  but 
in  this  country  also.3 

The  pleurisies  which  prevailed  in  Minorca,  in  1745-46,  and  of 
which  Cleghorn  has  left  us  so  graphic  a  description,  commonly 
began  like  an  ague  fit,  with  shivering  and  shaking,  flying  pains  all 
over  the  body,  bilious  vomiting  and  purging,  which  were  soon 

1  Bianchi,  Hist.  Hepat.  i.  236;  Stoll,  Med.  Constitution  of  years   1770-77,  i.  50; 
Frank,  pt,  2,  ii.  350  ;  Forsyth,   Med.   Rep.  xii.  353  ;  Williams,   Med.   Reg.  iii.  454 ; 
Potter,  Med.   Recorder,  iv.  404  ;  Drake,  i.  749,  765 ;   Wood,  ii.  38 ;  Pelletan,  Mem. 
Statist,  sur  la  Pleuro-pn.  Mem.  de  1'Acad.  de  Med.  viii.  443  ;  see  Bulletin  do  1'Acad. 
i.  835;  iv.  447;  Eberle,  Pract.  of  Med.  i.  284. 

2  Matheson,  Charleston  J.  iii.  152;  Oliver,  N.  0.  J.  vii.  387-89;  Day,  ibid.  ii.  578-587. 

3  Morton,  Opera  Omnia  Hist.  &c.  21 ;  Brera,  Journal  de  Sedillot,  xxxiii. ;  Bailly, 
Fievrcs  Intermittcntes,  253  ;  Gouzee   (of  Antwerp),  Archives,  2d  series,  iv.  71  ;  Da 
niel  (of  Cctte),   Ephemerides  de   Montpellier,  iv.   339,   357,   454;  Gouraud,   Etudes 
sur  les  Fievres  Interm.  103  ;  Sarcone,  Mai.  de  Naples,  i.  202 ;  Frank,  ii.  352 ;   Mou- 
ton,   An.   Clin.   de  Montpellier,  xxvii.   133  ;  Laennec,  i.  391,  4th  ed. ;  Alibert,    57  ; 
Bonnet,  F.  Interm.  76,  118;  Detournel,  Arch.  Gen.  April  1829,  p.  255 ;  Nepple,  F.  Int. 
99, 124,  260;  Roche  etBerquin,  Nouv.  Elem.i.  440;  Leonard  and  Foley,  Researches  sur 
1'Etat  du  Sang,  &c.  en  Algerie,  Mem.  de  Med.  and  de  Chir.  Militaire,  Ix.  135,  209  ;  De 
Renzi,  Miasmi  Paludosi,  121 ;  Lauter,  Hist.  Medica  Bienn.  Marb.  Rural,  5th  and  7th 
cases;  Strack,  Obs.  de  Feb.  Intermit.,  obs.  32,  58,  p.  74;  Sauvages,  Nosol.  Med.  ii. ; 
Abloing,  Journal  General  de  Medicine,  Iviii.  ;  Matthei,  Journal  do  la  Societe  Med.- 
Cliir.  de  Parme.  ii. ;  Bonakli,  ib. ;  Archier,  Journal  de  Med.  1784,  Ixi. ;  Evans,  54,  17, 
71,  78;  Chauffard,  Traite  des  Fievres,  254,  257;  Macculloch,  385;  Mongellaz,  221,  &c. ; 
Bibliothique  Med.  Jan.  1819,  from  Tr.  of  Med.  Soc.  of  Lyons,  N.  A.  Med.  and  Surg.  J. 
viii.  193;  Du  Pro,  Charleston  J.  v.  607,  608;  Maillot,  17,  41,  127;  Raymond,  Mem. 
de  la  Soc.  Roy.  de  Med.  iv.  72  ;   Foster,  Stethoscope,  iii.  91-93 ;  Blake,  N.  0.  J.  vii. 
510,  511;  Rochoux,  Bulletin  de  1'Acad.  i.  926;  Cooke,  Recorder,  vii.  459 :  Meli,  Sulle 
Febbrc  Biliosi,  54,  55. 


440  PNEUMONIA    AND 

succeeded  by  quick  breathing,  immoderate  thirst,  inward  heat, 
headache,  and  other  feverish  symptoms.  In  a  few  hours,  the  respi 
ration  became  more  difficult  and  laborious ;  the  most  part  of  the 
sick  being  seized  with  stitches  in  their  sides.  In  a  few  instances 
these  complaints  preceded  the  fever ;  in  others  they  did  not  come 
on  till  the  day  after.  Many  were  drowsy,  and  inclinable  to  sleep, 
but  they  raved  at  intervals,  or  were  much  disturbed  with  extrava 
gant  dreams.  In  the  mean  time,  the  internal  heat  was  in  several 
very  moderate ;  in  some  less  than  natural ;  but,  for  the  most  part, 
it  was  so  intense  as  to  raise  the  thermometer  to  the  102d  degree; 
and  often  in  the  afternoon  to  the  104th.  The  pulse  was  likewise 
very  variable,  not  only  in  different  persons,  but  in  the  same  at  dif 
ferent  times.  In  some  cases  it  was  like  that  of  a  man  in  health,  or 
even  slower  than  natural,  while  the  patient  was  in  the  greatest 
danger  ;  so  that  it  could  neither  be  depended  upon  as  a  prognostic 
sign,  nor  as  an  indication  of  cure.  Nor  was  the  colour  or  con 
sistence  of  the  blood  more  to  be  trusted ;  in  many  it  had  a  white 
or  pale  yellow  crust,  the  serum  being  of  the  same  complexion ;  but 
for  the  most  part  it  was  red  and  florid.  Besides  some  abatement 
of  the  fever,  which  commonly  happened  every  morning,  it  was 
remarkable  that  upon  the  third  day,  or  beginning  of  the  fourth, 
there  was  frequently  a  great  remission,  sometimes  a  total  cessation 
of  every  violent  symptom,  so  that  the  sick  were  thought  to  be  out 
of  danger ;  but  on  the  fourth  or  fifth,  a  delirium  suddenly  came  on, 
or  the  breathing  became  more  difficult  than  ever,  and  one  or  both  of 
these  symptoms  increasing  hourly,  the  patient  expired  in  a  day  or 
two,  either  suffocated  or  raving  mad,  unless,  nature  or  art  assisting, 
he  had  the  good  fortune  to  escape  by  some  critical  evacuation.1 

In  the  bilious  pleurisy  or  pneumonia  of  many  regions  of  our 
country,  the  reader  will  recognize  a  disease  much  resembling  the  pre 
ceding,  and  which,  unless  biased  by  strong  theoretical  prepossession, 
he  cannot  fail  to  regard  as  the  result  of  the  combined  agency  of 
miasmata  and  atmospheric  vicissitudes.  The  following  description 
of  the  disease,  by  Dr.  Eberle,  embodies  all  that  need  be  said  on  the 
subject.  The  initial  symptoms  differ  very  little  from  those  which 
usually  usher  in  an  attack  of  ordinary  remittent  bilious  fever.  In 
some  instances,  a  sense  of  fulness  and  tension  is  experienced  in  the 
right  hypochondrium,  a  few  days  previous  to  the  supervention  of 

1  Dis.  of  Minorca,  2G1-2GG. 


AUTUMNAL    FEVERS.  441 

the  disease,  and  occasionally  dysenteric  symptoms  occur  before  the 
fever  commences.  In  almost  all  the  cases  considerable  pain  is  felt 
in  the  back  and  extremities  during  the  premonitory  period.  The 
skin,  from  the  beginning,  is  more  or  less  tinged  with  bile,  and  the 
conjunctiva  especially  is  conspicuously  icterode.  The  face  is  flushed, 
and  a  sickly  mixture  of  red  and  yellow,  upon  close  examination, 
betrays  the  existence  of  a  disturbed  state  of  the  liver.  Acute  pain 
in  the  forehead  is  almost  constantly  present.  The  pain  in  the  chest 
is  sometimes  extremely  severe  and  pungent ;  but  more  commonly 
it  is  obtuse,  and  attended  with  a  sense  of  weight  or  oppression  in 
the  breast.  In  some  cases  the  fever  continues  for  several  days 
before  the  pectoral  pain  supervenes.  The  expectoration  is  not  very 
copious,  the  sputa  being  of  a  frothy,  yellowish  appearance,  marked 
frequently  with  streaks  of  blood.  The  fever  is  generally  attended 
with  manifest  evening  exacerbations,  and  morning  remissions. 
When  vomiting  takes  place,  an  occurrence  very  common  in  this 
affection,  more  or  less  of  bilious  matter  is  generally  thrown  up, 
although  in  some  instances  the  secretion  of  bile  appears  to  be  en 
tirely  suspended ;  the  ejections  consisting  of  nothing  else  than 
gastric  mucus  and  the  ingesta.  The  tongue  is  at  first  white,  with 
a  yellowish  streak  along  the  middle,  which,  as  the  disease  advances, 
becomes  dark  brown  and  dry.  The  urine  is  always  of  a  deep  yel 
low  or  bilious  colour ;  and  the  pulse  is  generally  small,  frequent, 
and  quick,  with  a  slight  degree  of  preternatural  tension.1 

In  the  following  statement  we  certainly  do  not  recognize  the 
phenomena  of  the  ordinary  and  legitimate  form  of  pneumonia,  or 
pleuro-pneumonia,  and  must,  as  in  the  preceding,  admit  the  admix 
ture  of  some  of  the  characteristics  of  malarial  fevers.  The  vicinity  of 
marshes  within  the  tropics,  and  in  countries,  during  the  summer  and 
autumn,  subject  to  tropical  heat,  says  Chisholm,  is  always  influential 
in  the  formation  of  the  type  and  character  of  the  disease.  This  is  re 
markably  exemplified  in  dysentery  and  pneumonia.  In  the  latter  it 
"  gives  the  disease,  originating  in  suspension  or  interruption  of  the 
functions  of  the  cutaneous  organization,  a  remittent  or  intermittent 
form.  In  fevers  of  an  infectious  nature,  whether  symptomatic  or 
idiopathic,  the  same  type  is  communicated  by  the  reception  of  the 
marsh  miasmata  into  the  system,  without  suspending  or  changing 
the  original  diathesis.  Thus  smallpox,  measles,  and  scarlatina  have, 

1  Treatise  on  the  Practice  of  Medicine,  i.  284. 


44:2  PNEUMONIA    AND 

in  such  situations,  a  remittent,  or  even  an  intermittent  form  of 
symptomatic  fever ;  and  thus,  from  the  same  cause,  idiopathic  in 
fectious  fever  has  often  superadded  the  type.  All  these,  therefore, 
under  such  circumstances  of  locality,  are  truly  hybrid  diseases; 
although,  in  their  treatment,  the  original  disease  is  alone  to  be  re 
garded.  In  hybrid  pneumonia,  the  pneumonic  symptoms  and  fever 
are  concomitant,  and  affect  the  patient  according  to  the  type  of  the 
latter;  in  paroxysms,  if  it  is  intermittent;  in  remissions  and  exacer 
bations,  if  it  is  remittent;  that  is,  the  pneumonic  symptoms  are 
always  exasperated  during  the  presence  of  the  fever,  and  mitigated 
during  its  intermission  or  remission."1 

As  we  have  seen  in  the  opening  chapter  of  this  volume,  Dr. 
Yaughan,  of  Delaware,  founded  his  opinion  regarding  the  identity- 
pathological  and  etiological — of  pneumonia  and  fever,  partly  on  the 
occurrence  of  cases  of  the  former  in  which  the  pulse  presented 
peculiar  characters,  the  fever  had  a  tendency  to  assume  a  tertian 
type,  and  the  countenance  became  early  hippocratic.2  We  have 
seen  also  that  Dr.  Forry  inclined  to  the  same  opinion,  because 
sundry  cases  reported  by  Drs.  Pitcher  and  Wharton,  of  the  army, 
partook  of  the  intermittent  character,  and  were  successfully  treated 
by  the  same  remedies  which  are  found  to  arrest  intermittent  fevers.3 
A  farther  proof  of  the  existence  of  such  cases  will  be  obtained  by 
referring  to  the  great  work  of  Dr.  Drake,  as  well  as  to  an  essay  by 
Dr.  Boling,  of  Montgomery,  Ala.,  in  which  the  blending  of  the  peri 
odic  type  with  pulmonary  and  other  inflammations,  is  ably  treated 
and  amply  illustrated  by  interesting  cases.4 

Within  the  last  few  years,  as  we  learn  from  the  Charleston  Hfedical 
Journal,  even  thoracic  diseases — bronchitis,  pneumonitis,  pleuritis, 
&c.  (while  retaining  their  distinctive  characters),  have  taken  on  a 
strongly-marked  periodical — intermittent  or  remittent — character. 
Two  years  ago,  in  Charleston,  almost  all  the  cases  of  the  above- 
mentioned  diseases  were  of  this  nature,  and  were  promptly  checked 
by  quinia.5  Nor  is  it  in  the  south  alone  that  such  a  tendency  has 
been  noticed.  Dr.  Rush,  in  his  account  of  the  bilious  fever  which 
prevailed  in  Philadelphia  in  1780,  states  that  in  the  spring  of  that 
year,  a  catarrh  appeared  among  children,  from  one  to  seven  years 
of  age.  "  It  was  accompanied  by  a  defluxion  from  the  eyes  and 

1  Manual  of  the  Climate  and  Diseases  of  Tropical  Countries,  10G. 

2  Med.  Repos.  iv.  130.  3  Climate  of  the  U.  S.  18G. 
4  Am.  J.  of  Med.  Sc.  viii.  87,  and  X.  S.       5  Vol.  v.  824. 


AUTUMNAL   FEVERS.  443 

nose,  and  by  a  cough  and  dyspnoea,  resembling  in  some  instances 
the  cynanche  trachealis,  and  in  others  a  peripneumony.  In  some 
cases  it  was  complicated  with  the  symptoms  of  a  bilious  remittent 
and  intermittent  fever.  The  exacerbations  of  this  fever  were  always 
attended  with  dyspnoea  and  cough."1  Among  the  sick  labouring 
under  the  fever  they  had  brought  to  England  from  "Walcheren,  or 
who  were  attacked  after  their  return  from  the  latter  place,  pneu 
monia  was  of  common  occurrence,  especially  about  the  month  of 
November,  when  they  were  exposed  to  the  combined  influence  of 
cold  and  humidity.  In  such  cases  the  pulmonary  influence  was 
modified  in  its  type  and  other  peculiarities  by  the  paludal  fever 
with  which  it  was  associated.2 

Sir  George  Baker,  in  his  description  of  the-  influenza  of  1762, 
states  that  the  disease  exhibited  the  intermittent  character.  "  Some 
times  it  proved  periodical,  and  of  the  tertian  type."3  Dr.  Holland 
made  the  same  observation  in  London,  during  the  epidemics  of 
that  disease  which  prevailed  there,  from  1831  to  1838,  remarking 
that  the  tendency  to  intermittent  symptoms,  both  tertian  and  quo 
tidian  in  type,  and  often  very  regular  in  period,  seemed  to  be  more 
common  when  the  disorder  was  abating.4  A  similar  fact  was  no 
ticed  by  Dr.  Rush,  who,  in  his  history  of  the  influenza  of  1807, 
observes :  "  The  bilious  fever  which  prevailed  in  August  imparted 
to  it  several  of  its  symptoms.  There  were  obvious  remissions  and 
intermissions,  great  pain  in  the  back,  and  apparent  cessation  of  the 
symptoms  of  the  disease  on  the  third,  and  a  return  of  them  on  the 
fourth  day,  &c.  The  disease  appeared  in  one  respect  to  be  a  mon 
ster  ;  its  head  and  breast  wore  the  character  of  influenza,  while  its 
trunk  and  limbs  indicated  it  to  be  a  bilious  fever."5 

Pneumonia  and  other  inflammations  presented  the  periodic  ele 
ment,  and  other  phenomena  appertaining  to  malarial  fevers,  during  an 
epidemic  of  the  latter  which  prevailed  at  Auch  (France)  a  few  years 
ago,  a  description  of  which  was  given  by  an  able  physician  of  the 
place,  M.  Campardon.6  Dr.  Constant,  who  practises  in  one  of  the 
marshy  districts  of  the  Department  of  the  Lot  in  France,  has  seen 

1  Works,  ii.  231. 

2  Davis,  Scientific  and  Popular  View  of  the  Fever  of  Walcheren,  10-42. 

3  Treatise,  &c.  in  Collection  of  the  Sydenham  Soc.  73. 

4  Medical  Notes — Connection  of  Certain  Diseases,  64.     Am.  Ed. 

5  Vol.  iv.  101. 

6  Bulletin  de  1'Acad.  de  Med.  viii.  634. 


444  PNEUMONIA    AND 

much  of  that  form  of  disease,  and  draws  attention  to  the  signs  which 
distinguish  it.  The  initial  shivering  is  more  intense  and  prolonged 
than  in  ordinary  pneumonia ;  the  local  pain  is  felt  early,  and  always 
in  front  of  the  chest,  although  the  congestion  is  localized  posteriorly ; 
it  is  more  amenable  to  blisters  than  to  leeches ;  violent  headache 
comes  on  early,  and  is  either  frontal  or  sincipital ;  there  is  often  severe 
lumbar  pain,  which  observes  the  same  stages  of  increase  and  de 
crease  as  the  headache ;  the  shivering  is  followed  by  intense  heat, 
which,  after  several  hours,  gives  place  to  abundant  sweating ;  the 
pulse,  during  the  paroxysm,  in  place  of  being  full,  strong,  and 
vibrating,  as  in  ordinary  pneumonia,  is  rapid,  soft,  undulating,  and 
compressible;  there  is  never  any  purulent  expectoration,  these 
pneumonias  never  proceeding  beyond  the  second  stage,  i.  e.  red 
hepatization,  the  pulmonary  engorgement  being  rather  a  sangui 
neous  congestion  than  inflammation;  auscultation  shows  the  rapid 
passage  from  the  first  to  the  second  stage ;  for  eight  or  twelve  hours 
will  be  sufficient  for  the  passage  from  a  circumscribed  rale  to  the 
hepatization  of  a  whole  side.  The  disease  especially  appears  in 
summer  and  autumn,  while  ordinary  pneumonia  prevails  in  spring 
and  winter.  The  blood  from  a  vein  is  often  below  the  normal  tem 
perature,  very  black,  and  deficient  in  plasticity.  After  rest,  its 
surface  acquires  a  bluish  colour,  especially  if  the  patient  is  taking 
quinia.  The  clot  is  slow  in  forming,  and  soft.  The  buffy  coat  is 
absent,  or  very  thin,  and  inclines  to  a  bluish  colour.  In  the  dis 
trict  where  the  form  of  pneumonia  here  described  is  seen,  purely 
inflammatory  pneumonia  is  observed  during  winter ;  but,  in  propor 
tion  to  the  high  temperature  and  the  production  of  malarial  emana 
tion,  this  inflammatory  element  is  replaced  by  the  paludal  one.1 

In  the  foregoing  instances  we  certainly  have  pulmonary  inflam 
mation  ;  but  the  form  which  the  disease  assumes  differs  somewhat 
from  that  we  see  elsewhere.  It  is  peculiar  in  its  type,  in  the  greater 
length  and  distinctness  of  its  remissions,  and  in  the  gastric  and  bilious 
symptoms  by  which  it  is  accompanied;  as  well  as  in  the  condition 
of  the  blood,  pulse,  skin,  and  expectoration.  Everything,  indeed, 
affords  proof  of  the  existence  of  a  periodic  or  malarial  element. 

1  British  and  For.  Med.-Chir.  Rev.  xii.  552,  from  the  Bulletin  de  Therapeutique, 
xliii.  481-491. 

The  same  complication  is  noticed  on  a  large  scale,  both  as  regards  pneumonia  and 
pleurisy,  in  Rio  Janeiro  and  other  parts  of  Brazil,  where,  as  we  learn  from  Sigaud,  who 
mentions  the  fact,  the  periodic  or  malarial  element  associates  itself  to  all  diseases. 
See  his  excellent  work  on  the  climate  and  diseases  of  that  country,  pp.  301-304. 


AUTUMNAL   FEVERS.  445 

Though  sometimes  encountered  in  ordinary  fever  seasons,  and  in 
most  places  subject  to  malarial  fevers,  and  though  more  particu 
larly  rife  in  times  of  violent  and  wide-spreading  epidemics,  and  in 
very  sickly  localities ;  this  complication  of  inflammation  of  the  lungs 
with  miasmatic  fever  is  not  unfrequently  found  to  occur  under 
circumstances  of  a  different  kind ;  for,  by  virtue  of  the  power  of 
latency  possessed  by  these,  the  system  remains  predisposed  to 
them ;  and  the  same  exciting  cause  which  occasions  an  attack  of 
pneumonia,  long  after  or  in  a  healthy  season,  calls  into  activity 
the  malarial  poison,  and  the  result  is  the  compound  disease  under 
consideration.  This  condition  of  things  has  been  observed  in  all 
miasmatic  countries,  and  nowhere  more  strikingly  than  in  our  own. 
By  more  than  one  of  our  southern  physicians  who  have  not  adopted 
the  views  at  present  under  examination,  we  shall  be  told,  that,  as 
many  carry  the  predisposition  to  miasmatic  diseases  throughout  the 
autumn  without  having  fever  excited,  so  some  continue  to  retain 
it  in  the  winter,  and  on  some  sudden  exposure  to  cold,  which  often 
produces  it  in  the  autumn,  fever  is  excited  in  those  who  continue 
in  that  state;  or  if  the  approach  of  cold  weather  be  sudden  and  ex 
cessive,  before  the  predisposition  is  done  away,  and  proper  provi 
sion  made  against  the  weather,  the  number  affected  is  greater.  In 
the  winter  following  those  seasons  in  which  miasmata  abound,  the 
number  of  persons  remaining  predisposed,  and  the  predisposition 
itself,  are  greater.  Sudden  cold,  then,  produces  many  cases  of  com 
bined  symptoms  of  summer  and  winter  disease.1 

But  neither  in  these  instances,  numerous  and  interesting  as  they 
doubtless  are,  nor  in  those  cases  of  remittent  or  intermittent  perito 
nitis,  rheumatism,  ophthalmia,  apoplexy,  hemiplegia,  convulsions, 
meningitis,  lunacy,  of  which  we  read  in  the  writings  of  Torti, 
Morton,  Morgagni,  Elliotson,  Macculloch,  Mongellaz,  Gouraud, 
Lay  cock,  Boling,2  and  examples  of  some  of  which  I  have  myself 
not  seldom  observed  in  this  country  and  Europe,  can  we  dis 
cover  any  good  reason  for  creating  a  new  class  of  diseases,  distinct 
from  the  ordinary  inflammation,  congestion,  or  irritation  of  the 
parts  affected,  both  as  regard  cause  and  nature.  Still  less  are 
we  justified  in  admitting  the  identity  of  the  two  diseases  repre 
sented  in  the  compound  of  phenomena  noticed,  or  that  the  one 

1  Cooke,  Med.  Recorder,  vii.  460. 

2  See  also  Med.-Chir.  Trans,  iii.  348;  Med.  Gaz.  iv.  116;  Med.-CMr.  Rev.  xiv.  514; 
London  Lancet,  i.  425. 


446  PNEUMONIA    AND 

is  a  modification,  or  really  and  substantially  nothing  more  than  a 
peculiar  form  of  the  other.  To  me,  as  also  to  some  of  the  writers 
just  referred  to,  and  to  many  more  I  might  cite,  all  these  cases  fur 
nish  illustrations  of  the  complication  or  coexistence  of  two  distinct 
complaints,  produced  by  distinct  causes,  having  distinct  seats  and 
characters,  and  being  governed  by  different  laws,  but  which  often 
modify  each  other  to  a  greater  or  less  extent. 

Similar  views  were  long  entertained  by  high  professional  authori 
ties.  In  an  excellent  essay  on  the  "  relation  existing  between  epi 
demic  and  other  diseases  prevailing  at  the  same  time  and  place, 
and  denominated  intercurrent,"1  Kaymond,  among  others,  in  refer 
ence  to  facts  he  had  observed  during  a  long  series  of  years,  dwelled 
at  some  length  on  the  complication  of  pneumonia  with  the  epidemic 
or  stationary  constitution  of  the  atmosphere  existing  at  the  time  the 
disease  happens  to  show  itself,  and  remarked :  "  Those  kinds  of 
thoracic  inflammations  have  constantly  assumed  the  types  of  the 
epidemic  constitution  during  the  existence  of  which  they  appeared. 
They  have  engrafted  themselves  on  the  epidemic  or  constitution  of 
the  year,  and  presented  the  same  symptoms  and  the  same  functional 
lesions,  in  addition  to  the  affection  of  the  respiratory  organs  which 
characterizes  them  in  a  special  manner.  Apart  from  the  expectora 
tion,  which  appertains  to  them,  their  march,  their  critical  movements, 
and  their  mode  of  termination,  were  the  same.  Inflammation  of 
the  lungs  is,  therefore,  composed  of,  or  complicated  with,  the  sta 
tionary  modes  or  symptoms  of  the  constitution  or  epidemic  of  the 
year,  and  of  the  transient  and  intercurrent  constitutions  of  the  period 
and  of  the  seasons  from  which  they  arise."  If,  he  continues,  inter 
current  diseases  are  founded  on  constitutional  fevers,  in  their  turn 
intermittent  fevers  are  often  complicated  with  the  elements  by  which 
the  former  are  characterized. 

"While  the  Walcheren  fever  which  pursued  the  British  troops  to 
England,  or  attacked  them  after  their  return  home,  was  the  off 
spring  of  a  morbid  agent  which  had  impressed  the  system  in  a 
distant  land;  the  pneumonia  with  which,  as  we  have  seen  it  was 
often  combined,  was  the  effect  of  a  cause  appertaining  to  the  place 
where  the  complaint  showed  itself.  The  combination  thus  pro 
duced  must  consequently  be  regarded  as  the  result  of  the  action  of 
two  seperate  sets  of  causes,  and  hence  as  a  compound  of  two  inde- 

1  Mem.  de  la  Soc.  Roy.  de  Med.  iv.  72,  73. 


AUTUMNAL    FEVERS.  447 

pendent  diseases.  Dr.  Davis,  who  calls  attention  to  the  occurrence 
in  question,  evidently  takes  this  view  of  the  subject.  After  remark 
ing,  that  all  the  important  consequences  entailed  by  protracted 
intermittent,  comprehended  enlargement  of  the  liver  and  spleen, 
wasting  of  the  omentum,  inflammation  of  the  peritoneal  cavity  of 
viscera,  extensive  adhesions  of  the  abdominal  viscera  to  each  other, 
scirrhosity  of  the  pancreas,  enlargement  of  the  mesenteric  glands, 
chronic  inflammation  of  the  intestines,  dropsy,  jaundice,  &c.  he 
adds :  "  The  chief  disorders  combined  with  intermittent  were  pneu 
monia  and  angina.  I  have  known  pneumonia  to  be  repeatedly 
combined  with  simple  and  double  tertian  paroxysms;  and  in  Chap 
man's  Medical  Commentaries,  there  is  a  corroboration  of  pulmonary 
complaints  assuming  an  intermittent  type.  Though  it  is  a  fact  that 
autumnal  intermittents  are  apt  to  run  into  dysentery,  and  vernal 
intermittents  to  attack  the  lungs,  yet  one  of  the  most  frequent  com 
binations  of  the  protracted  fever  of  "Walcheren  was  inflammation 
of  the  lungs,  an  affection  that  became  very  frequent  in  November, 
and  that  generally  ended  fatally."  Section  8  of  Dr.  Davis's  work 
is  headed,  "  Pneumonia  as  a  combination  with  the  primary  disease." 
He  therein  describes  a  peculiar  form  of  the  complaint,  to  which  the 
fever  patients  were  particularly  subject,  and  adds:  "Pneumonia 
never  was  symptomatic  of  the  Walcheren  remittent,  as  it  sometimes 
is  of  measles,  catarrh,  and  phthisis  pulmonalis ;  but  was  combined 
and  interwoven  in  a  particular  manner  with  it,  so  as  apparently  to 
constitute  a  part  of  the  same  disease."1 

The  true  nature  of  these  cases  did  not  escape  the  sagacity  of  our 
great  medical  philosopher,  Dr.  Drake.  "  The  lungs,  it  is  well 
known,"  as  he  remarks,  "  are  liable  to  inflammation  in  this  fever ; 
and,  instead  of  occurring  late  in  the  disease,  like  cerebritis,  it  gene 
rally  arises  at  an  early  period.  Such  inflammation  may  prove 
fatal ;  and  then  a  post-mortem  inspection  will  show  the  lesions  result 
ing  from  bronchitis  or  pleurisy,  but  more  frequently  still  those  of 
pneumonia,  such  as  sanguineous  engorgements  and  hepatization. 
But  they  cannot  be  regarded  as  constant,  essential,  or  characteristic 
of  autumnal  fever;  for,  first,  a  vast  majority  of  cases,  even  those 
which  prove  fatal,  do  not  present  a  single  symptom  of  pulmonary 
inflammation;  and,  second,  this  inflammation,  in  most  instances,  is 
the  undoubted  effect  of  sudden  changes  of  weather  in  the  latter  part 

1  Op.  cit.  42,  149,  153. 


448  PNEUMONIA    AND 

of  autumn,  and  must,  therefore,  be  taken  as  the  offspring  of  an 
incidental  cause,  acting  subsequently  to  that  which  produced  the 
fever."  (824.)  In  another  place,  Dr.  Drake  states  that  the  most 
frequent  of  the  complications  occasioned  by  the  influence  of  malarial 
fevers  is  that  presented  by  the  pneumonias  of  the  south,  and  also 
of  the  lakes  in  the  north  (765). 

Again,  in  speaking  of  the  complications  of  intermittent  with  other 
diseases,  the  same  eminent  writer  farther  says :  "  But  the  more  fre 
quent  and  formidable  of  these  complications  is  that  presented  by  the 
pneumonias  of  the  south,  as  also  on  the  shores  of  the  lakes  in  the 
north,  where  numerous  cases  occur,  which  the  profession  too  often 
find  unmanageable  by  any  method  of  treatment  they  have  been 
able  to  devise."  (i.  765.)  In  another  place,  he  calls  attention  to  the 
fact  that  the  subdiaphragmatic  viscera,  except  the  pancreas,  are 
subject  to  inflammation  in  remittent  fever,  and  says :  "  Sometimes, 
however,  from  idiosyncrasy,  or  the  co-operating  action  of  other 
causes,  inflammation  in  other  parts  occurs,"  "  and,  when  the  fever 
makes  its  attack  late  in  autumn,  the  combined  action  of  vicissi 
tudes  of  temperature,  and  that  of  the  specific  cause,  developed  at 
an  earlier  period,  may  determine  inflammation  upon  the  lungs  or 
pleura."  (740.)  "  The  pneumonia  biliosa,"  says  Dr.  Potter,  "  is  a 
compound  affection,  originating  from  a  double  remote  cause."  "  It 
is  the  immediate  offspring  of  a  low  temperature,  engendered  upon 
a  miasmatic  predisposition."  (Op.  cit.) 

Dr.  Eberle  is  decided  in  the  opinion  that  this  variety  of  pneu 
monia,  which  occurs  during  cold  and  variable  seasons,  abounding 
in  sources  of  miasmatic  exhalations,  is  the  result  of  the  combined 
agency  of  koino-miasmata,  and  atmospheric  vicissitudes.  ( Op.  cit.  i. 
284.)  Other  references  to  the  same  object,  might  be  made,  for  there 
is  scarcely  a  writer  of  note  among  us,  or  elsewhere,  who  has  viewed 
suca  cases  in  a  different  light ;  but  the  above  will  suffice  to  show 
the  opinion  entertained  on  the  subject  by  high  authorities. 

The  lungs  become  implicated  in  a  number  of  diseases;  in  typhoid 
and  typhus  fevers,  the  complication  is  of  great  frequency,  and  has 
been  long  recognized  as  such,  as  the  writings  of  Huxham1  and  others 
will  fully  attest.  This  eminent  physician  informs  us,  that  at  Ply 
mouth,  in  1740  and  1745,  abundance  of  people  were  seized  with 
shivering,  then  great  heats,  fever,  and  difficulty  of  breathing;  impor- 

1  Essay  on  Fever,  59-61 ;  Obs.  on  Air  and  Epid.  Dis.  ii.  59. 


AUTUMNAL   FEVERS.  449 

tunate,  laborious  cough ;  very  acute  darting  pains  of  the  breasts,  sides, 
and  back ;  frequent  also  in  the  head  and  temples.  They  had  often 
times  a  very  quick,  hard  pulse,  but  concentrated,  as  it  were.  The 
breath  was  very  hot  and  offensive,  and  the  matter  they  expectorated 
was  sometimes  thin  and  crude;  sometimes  as  yellow  as  saffron,  but 
more  commonly  a  thin,  gleety,  bloody  matter ;  frequently  very  fetid, 
and  sometimes  so  acrid  as  to  cause  a  great  hoarseness  and  soreness 
of  the  windpipe  and  throat,  and  sometimes  excoriations  of  these 
parts.  The  blood  drawn  from  them  was  either  of  a  darkish-livid 
colour,  covered  over  with  a  lead-coloured  or  greenish  thin  film,  or 
sometimes  quite  florid  (particularly  on  the  first  bleeding),  but  of  a 
loose,  soft  consistence  when  cold.  In  others,  the  blood  drawn  was 
covered  over  with  a  pretty  thick  tough  coat,  "  not  of  a  whitish-yel 
low  colour,  as  usual  in  common  pleuritic  or  pleuro-peripneumonic 
blood,  but  of  a  colour  approaching  to  that  of  cornelian  stone,  or  a 
little  more  dilute  than  that  of  the  common  jelly  of  red  currants." 
The  urine  was  commonly  very  high,  and  sometimes  dark-coloured, 
with  a  kind  of  lead-coloured  sediment;  it  was  generally  rendered 
in  small  quantities.  Faint,  uncertain,  partial  sweats  often  attended, 
particularly  about  the  face  and  head ;  although  many  times,  towards 
the  fatal  period,  they  were  very  profuse  and  colliquative.  Livid  or 
black  spots  frequently  appeared  about  the  state,  and  seldom  or 
never  failed  of  being  the  certain  harbingers  of  death. 

Huxham  remarks  that,  at  the  same  time  when  this  malignant 
peripneumonia  reigned  at  Plymouth  and  its  neighbourhood,  pleuri 
sies,  peripneumonias,  and  pleuro-peripneumonias  were  everywhere 
epidemic,  and  generally  of  the  true  inflammatory  kind,  arising 
from  the  cold,  dry,  northerly  and  easterly  winds,  which  had  for  a 
long  time  prevailed.  "  Now  I  must  farther  take  notice,"  he  con 
tinues,  "  that  contemporary  with  both  these  disorders,  a  contagious, 
putrid,  petechial  fever  was  very  rife  in  and  about  this  town,  espe 
cially  among  the  sailors  and  prisoners,  and  those  that  were  very 
conversant  with  them ;  and  it  was  chiefly  among  those  sorts  of  per 
sons  that  the  malignant  pulmonic  fever  raged,  so  that  this  seemed 
to  be  a  complication  of  the  common  inflammatory  peripneumonia 
with  the  contagious  petechial  fever ;  the  contagious  effluvia  acting 
on  the  blood  in  the  manner  of  acrimonious  salts,  and  destroying  its 
crasis."  Montault1  found  inflammation  of  the  lungs  in  twelve  cases 

1  Mem.  de  1'Acad  de  M6d.  vii.  209. 

29 


450  PNEUMONIA    AND 

out  of  forty-eight  of  typhus.  Louis  found  it  in  somewhat  more  than 
one-third  of  his  cases.1  Attention  was  called  to  the  complication  by 
Sauvages,2  by  Fodere,3  Choinel,4  Bartlett,5  Parr,6  Low,7  Hosack,8 
Wood,9  and  a  hundred  others. 

In  these  cases,  pneumonic  symptoms  are  undoubtedly  modified 
to  a  greater  or  less  extent  by  the  febrile  poison,  and  the  disease  is 
not  unfrequently  wanting  in  the  pathognomonic  characters  which 
serve  to  distinguish  it  when  it  exists  alone.  But  in  most  cases  the 
thoracic  inflammation  is  easily  distinguished,  and  is  to  all  intents 
and  purposes  a  pneumonia  like  every  other  pneumonia,  bat  often, 
though  not  always,  partaking  largely  of  the  congestive  rather  than 
of  the  purely  inflammatory  character;  but  whatsoever  be  its  cha 
racter,  it  is  something  superadded  to  the  typhoid  fever,  and  form 
ing  no  essential  part  of  it.  In  the  disease  which,  since  the  days  of 
Sauvages,  has  very  generally  been  denominated  pneumonia  ty- 
phoides,  we  have  sometimes  a  primitive  or  pure  pneumonia,  which, 
as  it  progresses,  assumes  a  low  or  typhoid  character.  It  is  then 
constituted  of  common  pneumonia  and  a  typhoid  or  malignant  state 
of  the  system.  But  in  other  instances,  the  disease  presents  from 
the  outset  distinct  symptoms  of  both  pneumonia  and  typhoid  or 
typhus  fever.  It  is  therefore  a  mere  complication.  Such  was  found 
to  be  the  case  during  the  prevalence  of  the  disease  in  various 
parts  of  this  country  from  1807  to  1820.  As  remarked  before, 
typhoid  or  typhus  fever  extended  widely  and  fatally.  It  was 
attended  occasionally,  though  not  necessarily,  with  pneumonia; 
sometimes  with  inflammation  of  other  organs,  and  not  of  the  lungs. 
The  latter,  consequently,  formed  no  essential  part  of  the  disease; 
•and  when  it  occurred,  was  a  mere  complication.  Our  countryman, 
Dr.  Wood,  has  pointed  this  out  in  a  most  satisfactory  manner.10 
Dr.  Hosack  also  well  understood  the  nature  of  the  disease.  "  You 
have,"  he  says,  "  two  opposite  conditions  of  body  to  contend  with — 
local  inflammation  on  the  one  hand,  and  a  typhus  state  of  the  whole 
system  on  the  other.  The  causes  of  the  disease  are  no  less  compounded 
than  the  disease  itself.  The  local  inflammatory  affections  are  pro 
bably  occasioned  by  the  sensible  changes  of  the  atmosphere,  while 

1  DC  la  Fievre  Typhoide,  i.  300.  2  Nosologia,  i. 

3  Med.  L6g.  v.  351.  4  Lee.  dc  Mcd.  Clin. 

5  On  Fever,  111.  6  Die.  Art.  Pneumonia. 

7  Med.  Register,  iv.  25.  s  Med.  Register,  iii.  449. 

9  Practice,  ii.  39.  10  Op.  cit.  ii.  37. 


AUTUMNAL    FEVERS.  451 

the  typhoid  character  of  the  disease  is  derived  from  an  epidemic 
constitution  of  the  air,  the  same  which  has  given  rise  to  the  typhus 
petechialis,  or  spotted  fever,  which  prevailed  for  some  time  past  in 
our  northern  and  eastern  States,  and  which  is  doubtless  the  same 
disease  as  that  now  prevailing  in  Albany,  with  the  exception  that 
the  present  epidemic  is  complicated  with  the  symptoms  of  local 
inflammation  of  the  chest,  brain,  throat,  &c.,  the  effect  of  the  pre 
sent  cold  season  of  the  year."1 

The  complication  with  relapsing  fever  was  very  common  in  Ire 
land  in  1847.2  Like  symptoms  indicative  of  pneumonic  inflammation 
have  often  been  observed  in  the  plague,  and  pointed  out  by  many 
writers  from  the  days  of  Biverius.3  They  occur  in  several  eruptive 
complaints,  in  dysentery,  and  even  in  anaemia.  Why  should  it  not 
be  so?  Assuredly,  if  the  lungs  are  susceptible  of  taking  on  morbid 
action  through  the  effect  of  certain  causes,  in  persons  previously 
healthy,  they  cannot  help  being  more  likely  to  be  so  when  the  sys 
tem  is  labouring  under  disease;  and  when  all  the  organs  and  tis 
sues,  as  well  as  the  circulating  fluids  are,  consequently,  more  alive 
to  the  influence  of  morbific  agents.  Nor  is  it  difficult  to  under 
stand  how  the  inflammation,  by  which  they  are  attacked,  can 
awaken  into  activity  a  fever,  the  cause  of  which  had  lain  dormant 
in  the  system,  and  which,  when  developed,  continues  to  prevail  at 
the  same  time  with  the  disease  already  in  existence,  and  modifies  it 
to  a  greater  or  less  degree. 

But  these  secondary  attacks  are  mere  complications;  and  it  would 
be  just  as  reasonable  to  regard,  in  Ireland  and  France,  for  example, 
where  typhus  and  typhoid  fevers  are,  as  it  were,  endemic,  all  pneu 
monias  which,  occur  in  individuals  affected  with  those  diseases,  as 
due  to  the  causes  of  the  latter,  and  as  being  in  consequence  really 
and  substantially  nothing  more  than  a  peculiar  form  of  them,  as  to 
hold  all  pneumonias  observed  in  paludal  districts  and  during  fever 
seasons,  and  presenting  some  or  many  of  the  essential  characters  of 
autumnal  fevers,  as  the  offspring  of  the  paludal  poison,  or  as  a  mere 
form  of  that  class  of  complaints.  Inflammation  of  the  lungs,  there 
fore,  when  it  presents  itself  in  cases  characterized  by  symptoms  of 
periodic  or  autumnal  fevers,  is  to  be  viewed  in  no  other  light  than  as 
a  complication,  and  not  as  part  and  parcel  of  the  fever-in  question. 

1  Obs.  on  Peripn.  Typhoides,  now  prevailing  in  several  districts  of  the  U.  S.  1813, 
Med.  Regist.  iii.  450. 

2  Dublin  J.  viii.  334.  3  De  Feb.  Pestil.  ii.  05. 


452  PNEUMONIA    AND 

Each   disease   may,    and  often  does   exist   independently   of  the 
other;    but   both   may,  and  sometimes  do   coexist   in   the   same 
subject ;  and  while  in  such  cases  the  febrile  disease  is  due  to  its 
specific  poison,  the  pneumonia  arises  from   the  same   cause  that 
would   under    any   other   circumstances    have    produced   it.     In 
such  instances  of  complication,  each  of  the  two  diseases  may  be 
simply  modified  by,  or  as  it  were  tinged  with,   the   other,   i.  e. 
a   violent   pneumonia   may  present   feeble   symptoms   of  an  en 
demic  fever;  or,  vice  versa,  to  a  severe  attack  of  fever  may  be  asso 
ciated  symptoms  of  slight  pneumonic  inflammation.     In  some  cases 
they  start  together.     At  other  times  the  one  precedes  the  other ; 
the  former  acting  by  enhancing  the  susceptibility  of  the  system  to 
the  action  of  the  cause  producing  the  second;  or  calling  into  play 
morbid  conditions  which  before  had  lain  dormant  or  latent  in  the 
system.     To  this  it  may  be  added,  that  while  in  some  instances  the 
pulmonary  inflammation  is  subordinate  to  the  fever,  and,  so  long 
as  it  has  not  reached  beyond  the  first  stage,  disappears  during  the 
apyrexia  of  the  intermittent  form,  to  recur  again  with  the  accession 
of  the  fever ;  and  while  it  very  greatly  abates  with  the  subsidence 
of  the  hot  stage  or  exacerbation  in  the  remittent,  as  proved  by  the 
general  symptoms  and  physical  signs,  and  follows,  as  it  were,  the 
phases  of  its  associate;  in  other  and  probably  the  larger  number  of 
cases,  the  disease  only  abates  to  a  greater  or  less  extent,  but  does 
not  cease  in  the  first-mentioned  form,  and  does  so  but  slightly  in 
the  latter,  thus  showing  its  independent  existence.    Finally,  in  such 
complications,  it  has  not  unfrequently  happened,  that  the  periodic 
fever  has  been  arrested,  while  the  local  inflammation  has  continued 
to  run  its  course,  in  the  usual  way,  to  recovery  or  death.1 

The  complication  of  diseases  more  or  less  distinct  in  their  nature,  and 
the  modifying  influence  of  epidemic  over  other  complaints,  are  well  known 
to  etiologists  and patholo gists. — The  fact  of  malarial  fevers  engrafting 
themselves  on  other  complaints,  and  imparting  to  them  the  charac 
ter  of  periodicity,  is  perfectly  well  known  and  generally  admitted. 
It  is  one  of  such  frequent  occurrence  as  to  surprise  no  experienced 
and  observant  physician,  and  illustrates  while  it  confirms  what  has 
just  been  said  relative  to  the  complication  of  pneumonia  with 
some  or  more  of  the  phenomena  of  autumnal  fevers.  The  latter, 

1  Torti,  371,  476,  490,  405,  496;   Hippocrates  on  Popular  Med.  Hist.  vii. :   Mcr- 
gagui,  Letters,  31-33.    See  also  Bailly,  Mongellaz,  &c. 


AUTUMNAL   FEVERS.  453 

as  well  indeed  as  otlier  epidemic  and  wide-spreading  diseases,  have 
a  tendency  to  impress  their  livery  on  every  intercurrent  complaint, 
however  dissimilar  in  character ;  while  they  all,  in  their  turn, 
not  unfrequently  become  modified  by  other  diseases  that  assume  the 
epidemic  garb  and  prevail  in  greater  force.  And  I  need  scarcely 
remark,  that  such  an  effect  can  only  be  explained  on  the  principle 
that  such  epidemic  diseases,  arising  as  they  do  from  extensively 
diffused  and  powerful  causes,  complicate  to  a  greater  or  less  extent, 
and  add  a  few  or  more  symptoms  to  those  appertaining  to  other 
diseases,  by  which  individuals  exposed  to  their  morbid  influences 
may  be  attacked. 

The  effect  has  been  noticed  from  the  earliest  times,  even  from  the 
days  of  Thucydides,  who  remarks  that  the  epidemic  fever  of  Athens 
obliged  all  other  diseases  to  change  their  nature  by  assuming  some 
of  its  symptoms.  "  And  none  of  the  usual  endemic  maladies  made 
their  attacks  during  its  continuance ;  or,  if  they  did,  soon  terminated 
in  this."1  It  was  pointed  out  in  a  particular  manner  by  Sydenham, 
Hodges,  Huxham,  Storck,  Lepecque  de  la  Cloture,  by  our  own 
Kush,  and  after  him  by  other  writers.  See  what  takes  place  in 
regard  to  smallpox.  If,  in  certain  seasons,  according  to  Sydenham 
and  others,  this  disease  prevails  extensively,  the  fevers  which  ap 
pear  at  the  time  assume  an  inflammatory  character,  come  on  like 
the  variola,  have  kindred  phenomena — less,  however,  the  eruption — 
the  same  disposition  to  sweat,  salivation,  &c.  Thus,  in  the  epidemic 
smallpox  of  1667,  1668,  1669,  the  continued  fever  which  prevailed 
at  the  same  time  assumed  the  characters  of  that  disease,  and  was 
"  not  much  unlike  it,  except  in  the  eruption  of  the  pustules,  and 
the  symptoms  thereon  depending."  There  was  pain  over  the  pit 
of  the  stomach ;  chills,  headache,  heat,  absence  of  thirst ;  the  same 
appearance  of  the  tongue  and  urine ;  the  same  disposition  to  symp 
tomatic  and  profuse  sweat ;  to  petechi&3,  when  the  antiphlogistic 
treatment  was  not  pursued ;  the  same  tendency  to  salivation  which 
occurred  in  the  fever  when  the  inflammation  was  violent  and  ac 
companied  the  other  disease  when  of  the  confluent  kind.  So  alike, 
indeed,  were  the  two  diseases,  in  many  of  their  phenomena,  that 
"  with  the  exception  only  of  those  symptoms  which  were  the  neces 
sary  effects  and  consequences  of  the  eruptions,  it  was,  if  not  identi 
cal,  at  least  closely  akin  to  the  smallpox."  "  Finally,"  says  S.,  "  as 

1  Bk.  ii.  chap.  51.     Bloomfield's  Tr.  i.  413. 


454  PNEUMONIA   AND 

the  fever  was  most  rife  at  that  particular  time  when  the  ravages  of 
the  smallpox  were  greater  in  these  parts  than  at  any  other  time 
within  the  limits  of  my  own  observation,  there  can  be  but  little 
doubt  as  to  the  identity  of  character  between  the  two  diseases." 
"  For  this  reason,"  says  Sydenham,  after  recapitulating  the  whole, 
"  although  no  man  dislikes  the  coining  of  new  names  more  than 
myself,  I  may,  perhaps,  be  allowed  to  designate  the  present  fever 
as  the  variolous  fever,  from  its  likeness  to  the  smallpox  or  variola." 
The  practical  indications  were  manifestly  the  same  in  both  diseases, 
those  excepted  which  the  eruption  of  the  smallpox  and  the  symp 
toms  thence  arising  afforded,  and  which  could  not  be  expected  in 
this  fever,  because  it  was  not  attended  with  an  eruption.  The  disease, 
though  it  affected  fewer  persons  by  far  than  the  smallpox,  never 
theless  lasted  as  long;  but  in  the  winter,  when  that  abated,  this  pre 
vailed  ;  and  when  the  smallpox  returned  again  in  the  spring,  the 
fever  went  off,  so  as  thus  to  leave  the  smallpox  the  predominant 
epidemic  of  the  constitution  of  that  period.  The  fever,  notwith 
standing,  never  manifestly  ceased  during  this  space,  till  at  length 
it  totally  disappeared,  together  with  the  smallpox,  in  August,  1669. 
Notwithstanding  these  points  of  similarity,  the  fever  could  not  be 
regarded  as  cases  of  smallpox  without  eruption ;  for,  as  Sydenham 
remarks,  they  occurred  indiscriminately  in  all  classes,  though 
principally  among  adults,  the  greater  number  of  whom  had,  in  all 
probability,  passed  through  the  disease. 

It  may  be  useful  to  mention  that,  while  this  fever  still  survived, 
a  diarrhoea,  unaccompanied  by  any  manifest  febrile  symptoms,  was 
prevalent.  It  was  worse  in  1668.  Sydenham  says  that  at  that 
time  the  constitution  was  tending  towards  the  dysenteric,  which 
was  the  character  of  the  next  coming  years.  He  considered  this  to 
be  the  same  fever  with  the  variolous  fever  then  rife,  although  it 
took  another  form,  arid  exhibited  itself  with  a  fresh  symptom.  It 
was  observed  by  him  that  chills  and  rigors  preceded  the  diarrhoea. 
He  also  thought  it  evident  that  the  diarrhoea  itself  depended  on 
the  same  origin  with  the  fever.  Hence,  he  maintained  that  this 
fever  arose  from  the  inflammatory  rays  turned  inwards  towards 
the  intestines,  and  so  provoking  them  to  repulsion.  The  blood  in 
the  meanwhile  was  freed  by  this  division  from  those  disorders 
which  otherwise  would  have  been  caused  by  such  rays.  Besides 
this,  the  patient  could  not  bear  the  pit  of  the  stomach  to  be  touched 
by  the  hand — a  symptom  common  to  both  the  fever  and  the  small- 


AUTUMNAL   FEVERS.  455 

pox  of  tliis  constitution.  All  this  made  it  as  clear  to  him  as  the 
light  of  day,  that  .the  diarrhoea  was  of  the  same  nature  and  essence 
with  the  dominant  fever;  and  this  opinion  was,  he  thought,  con 
firmed  by  the  effect  of  venesection,  and  the  cooling  medicine,  regi 
men,  and  diet,  which  he  found  so  advantageous  in  the  fever.  They 
cured  the  diarrhoea  as  well ;  whilst,  if  treated  upon  a  different  prin 
ciple,  it  changed  its  character  from  a  mild  disease  to  a  deadly  one.1 

The  writings  of  Iluxham  contain  accounts  of  several  instances 
of  similar  complications.  In  1729,  in  the  month  of  July,  the  small 
pox  prevailed  much  at  Plymouth;  and,  during  this  month,  a  slow 
putrid  fever,  which  remitted  towards  the  end,  and  at  length  inter 
mitted,  became  very  epidemic  there.  It  chiefly  affected  the  head, 
stomach,  and  loins,  as  if  the  smallpox  was  coming  on,  and  was  at 
tended  with  an  oppression  at  the  breast,  sighing,  and  great  languor. 
Perhaps  it  was  such  a  kind  of  disorder  that  Sydenham  called  febris 
variolosa.  Children,  young  people,  women,  and  the  more  infirm, 
were  more  especially  attacked  with  it.  The  blood  drawn  from  them 
was  seldom  viscid;  the  urine  commonly  thin,  crude,  with  an  ash- 
coloured,  mucous,  and  imperfect  sediment,  as  if  made  up  of  wheaten 
bran.  The  more  perfect  the  sediment,  the  more  hope.  The  tongue 
was  not  very  dry,  but  daubed  over  with  a  glutinous  brown  mucus. 
Near  the  end  of  the  disease  a  diarrhoea,  and  sometimes  a  bloody 
dysentery,  was  greatly  urgent.  These  were  fatal  to  some.  But  a 
kind  of  red  petechias,  red  miliary,  itching  pustules,  or  large  sweats, 
breaking  forth,  most  commonly  quite  carried  off  the  fever.2  Some 
thing  of  the  same  kind  occurred  in  1740 ;  the  fever  was  modified 
by  the  smallpox.  In  1745  arid  1746  the  contrary  took  place.  The 
smallpox  was  modified  by  the  typhus  with  which  it  was  complicated.3 

Diemerbroeck  informs  us  that,  during  the  prevalence  of  the  plague 
in  Nimeguen  in  1635  and  1636,  all  the  intercurrent  diseases  which 
showed  themselves,  assumed,  before  the  close  of  twenty -four  hours, 
the  characters  of  the  reigning  epidemic;  and  during  a  whole  year, 
he  continues,  vix  ullus  morbus  peste  incomitatus  visus  fuerit.4  Senner- 
tus  observed,  during  the  great  plagues  of  1616  and  1626,  that  nearly 
all  other  diseases  disappeared ;  and  whenever  any  of  them  appeared 
and  lasted  a  few  days,  it  was  sure  to  become  complicated  with  the 

1  Vol.  5.  151,  152,  157,  158,  and  edit,  of  Sydenham  Society. 

2  Observations  on  the  Air,  and  Epidemic  Diseases,  i.  39,  40. 

3  Id.  ii.  60,  &c.  190,  &c.     Huxham  on  Fever,  3d  edit.  131,  &c. 

4  Tractatus,  De  Peste,  13. 


456  PNEUMONIA    AND 

prevailing  fever.  "  The  plague,"  says  Pugnet,  "  reigns  alone.  In 
saying  this,  I  do  not  wish  to  convey  the  idea  that,  when  in  all  its 
vigour,  it  puts  a  bar  to  the  development  of  all  other  diseases,  but 
that  it  stamps  its  characteristic  features  on  those  that  show  them 
selves  ;  assuming,  itself,  the  forms  imparted  to  it  by  the  tempera 
ment  of  the  individual  attacked."1 

A  more  recent  and  an  excellent  authority,  who  has  often  seen  and 
studied  the  disease  in  Constantinople,  remarks,  that  when  the  sickly 
season  arrives,  and  the  plague  breaks  out,  it  encounters,  besides  chro 
nic  diseases,  those  appertaining  to  the  season,  as  well  the  sporadic  as 
the  endemic  and  epidemic.  "  If  the  plague  is  mild,  the  intercurrent 
complaints,  and  also  those  existing  at  the  time,  are  uninfluenced  in 
their  progress.  Sometimes,  however,  the  regularity  of  their  symp 
toms  is  disturbed,  and  we  notice  a  concealed  plague,  or  a  painless 
exanthema.  If  the  plague  is  malignant,  its  deleterious  influence 
complicates  a  large  number  of  the  reigning  or  intercurrent  diseases, 
arrests  the  course  or  changes  the  character  of  their  symptoms,  in 
order  to  substitute  its  own.  It  dries  up  blistered  surfaces,  issues, 
and  setons ;  alters  the  character  of  the  pus  issuing  therefrom, 
causes  abortion,  &c.  If  the  epidemic  is  violent,  acute  and  chronic 
intercurrent  diseases  almost  invariably  experience  its  influence,  and 
the  mortality  among  those  affected  is  very  large.  In  seeing  the 
plague  ingraft  its  symptoms  on  those  of  the  larger  number  of  pre 
vailing  diseases,  the  public  fancy  that,  before  showing  itself  with 
its  legitimate  characters,  the  former  was  concealed  under  the  form 
of  those  various  diseases,  and  was  the  sole  cause  of  them.  The 
complaint  is  pronounced  to  be  proteiform,  and  people  are  no  longer 
astonished  at  the  errors  of  the  physicians ;  while,  in  truth,  the  effect 
is  only  due  to  a  deleterious  influence  added  to  the  pre-existing  dis 
eases,  and  affecting  the  systems  or  apparatus  of  the  economy  with 
a  force  proportioned  to  the  amount  of  their  irritability.2 

In  speaking  of  the  plague  of  London,  Dr.  Hodges  remarks,  that 
"  at  the  rise  of  the  plague  all  other  distempers  went  into  it ;  but 
that  at  its  declension,  it  degenerated  into  others ;  as  inflammations, 
headache,  quinsies,  dysenteries,  smallpox,  measles,  fevers,  and  hec 
tics,  wherein  the  plague  yet  predominated."3  Sydenham,  whose 
observations  extended  over  a  period  of  sixteen  years,  including  the 

1  Fievres  de  mauvais  caractere,  185.     See  also  Rapport  de  1'Acad.  52,  53,  G2. 

2  Braver,  Neuf  Annees  a  Constantinople,  ii.  289,  290. 

3  Loimologia,  26. 


AUTUMNAL    FEVERS.  457 

time  immediately  preceding  and  following  the  great  plague  of  Lon 
don,  calls  attention  to  the  fact  that  a  remarkable  change  took  place 
in  the  character  of  fevers  and  other  complaints,  approximating  the 
general  type  of  disease,  in  several  striking  features,  to  the  distin 
guishing  characteristics  of  the  pestilence  at  hand,  some  months 
before  that  dreadful  malady  assumed  its  distinct  and  proper  shape, 
which  it  did  at  last  quite  suddenly.  He  remarks  that  the  disease 
which  precedes  the  plague  changes  its  character,  and  is  accompanied 
with  a  multitude  of  anomalous  accidents.  "  It  is  like  a  monarch 
with  a  body-guard  of  foreigners."  Such  deaths  from  plague  as 
sporadically  occur  during  the  few  years  following  those  of  the 
great  plague,  and  which  gradually  decrease  and  finally  vanish  alto 
gether,  are  to  be  attributed  to  a  partial  persistence  of  the  pestiferous 
disposition  of  the  atmosphere,  which  has  not  yet  undergone  its  full 
change  from  foul  to  healthy.  Deaths,  in  years  like  these,  are  only 
the  gleanings  of  the  harvest  that  has  gone  before ;  and  it  is  from 
traces  of  former  infection  that  the  fevers  of  the  first  year  or  two 
after  great  plagues  take  a  pestilential  character ;  of  true  plague, 
indeed,  they  want  some  of  the  characteristics.  Notwithstanding 
this,  they  resemble  it  exceedingly  in  character  and  disposition,  and, 
as  shown  below,  demand  a  similar  line  of  treatment."  (i.  99.)  Again, 
in  speaking  of  the  epidemic  coughs  of  the  year  1675,  he  says: 
"And  here  I  must  again  remark  that,  in  the  treatment  of  fevers, 
the  physician  who  does  not  keep  continually  before  his  eyes  the 
constitution  of  the  year,  the  extent  to  which  it  favours  the  epidemic 
production  of  this  or  that  disease,  and  the  power  it  has  of  twisting 
to  its  own  proper  shape  and  likeness  all  the  other  concurrent  dis 
orders  of  the  time,  wanders  widely  in  a  maze  without  a  clew."  (i.  230.) 
Dr.  Rush,  in  his  account  of  the  Scarlatina  Anginosa,  which  pre 
vailed  in  Philadelphia  in  1783  and  1784,  says:  "Intermittent  fever, 
which  made  its  appearance  in  August,  was  not  lost  during  the 
month  of  September.  It  continued  to  prevail,  but  with  several 
peculiar  symptoms.  In  many  persons  it  was  accompanied  by  an 
eruption  on  the  skin,  and  swelling  of  the  hands  and  feet.  In  some, 
it  was  attended  with  sore  throat,  and  pains  behind  the  ears.  Indeed, 
such  was  the  predominance  of  the  scarlatina  anginosa,  that  many 
hundred  people  complained  of  sore  throats,  without  any  other 
symptom  of  indisposition.  The  slightest  occasional  or  exciting 
cause,  particularly  cold,  seldom  failed  of  producing  the  disease,"1 

1  Vol.  ii.  245. 


458  PNEUMONIA    AND 

Dr.  Southgood  Smith  has  remarked  that,  during  the  six  months 
immediately  preceding  the  appearance  of  cholera  in  England,  the 
character  of  fever  in  London  so  entirely  changed,  that  typhus, 
which  for  a  long  series  of  years  had  been  essentially  an  inflam 
matory  disease,  became  a  disease  of  debility,  so  closely  resembling 
cholera,  that  the  fever  into  which  cholera  patients  commonly  fell, 
could  not  be  distinguished  from  the  primary  fever  found  in  the 
wards  of  the  fever  hospital  when  cholera  was  at  its  height,  which 
had  appeared  there  for  the  first  time  six  months  previously,  but 
which  has  never  disappeared  since.1  So  also  in  all  our  yellow 
fever  epidemics,  every  intercurrent  disease  assumed  to  a  greater  or 
less  extent  the  character,  and  presented  some  of  the  phenomena,  of 
the  reigning  complaint.2 

The  same  absorbing  power — the  same  influencing  agency,  is  as 
cribed  by  Desportes  to  the  yellow  fever  of  St.  Domingo.  Speaking 
of  the  epidemic  which  prevailed  in  the  City  of  the  Cape,  in  1733, 
he  informs  us  that  the  violence  of  the  disease  was  such  that  it 
lulled  all  other  diseases,  and  reigned  alone.  "  This  is  the  character 
of  all  contagious  and  pestilential  diseases.  Sydenham,  and  before 
him  Diemerbroeck,  had  remarked  it  of  the  plague."3 

Dr.  Chisholm  makes  a  similar  remark  in  relation  to  the  epidemic 
fever  which  prevailed  so  extensively  at  St.  George,  Grenada,  in  the 
year  1793.  Most  other  diseases,  he  says,  degenerated  into  or  par 
took  very  much  of  the  nature  of  this.  Dysenteries  suddenly  stop 
ped,  and  were  immediately  succeeded  by  the  symptoms  of  the  pes 
tilential  fever.  Catarrhal  complaints,  simple  at  first,  soon  changed 
their  nature ;  convalescents  from  other  diseases  were  very  subject 
to  this,  but  it  generally  proved  mild.  Those  labouring  at  the  time 
under  chronic  complaints,  particularly  rheumatism  and  hepatitis, 
were  also  very  subject  to  it.  The  puerperal  fever  became  malig 
nant,  and  of  course  fatal ;  and  even  among  pregnant  negro  women, 
who  otherwise  might  have  had  it  in  the  usual  mild  degree  peculiar 
to  that  description  of  people,  were  reduced  to  a  very  dangerous 
situation  by  it.  In  short,  every  disease,  in  which  the  patient  was 
exposed  to  infection,  sooner  or  later  assumed  the  appearance,  and 
acquired  the  danger,  of  the  pestilential  fever.4 

Dr.  James  Clark  states  that,  in  1793,  children,  adults,  and  old 

1  General  Board  of  Health's  Report  on  Quarantine,  13. 

2  Rush,  iii.  76,  79.  3  Maladies  tie  St.  Domingue,  40,  41. 
4  Op.  cii.  i.  180-182. 


AUTUMNAL    FEVERS.  459 

people  labouring  under  smallpox,  were  attacked  with  the  yellow 
fever  about  the  time  the  secondary  fever  generally  came  on,  whether 
the  disease  assumed  the  confluent  or  simple  form.1  Dr.  Eush  re 
marks  that  the  bilious  remittent,  or  break-bone  fever,  which  pre 
vailed  in  Philadelphia  in  1780,  chased  away  every  other  febrile 
disease,  or  blended  itself  with  the  intercurrent  diseases.2  In  his 
account  of  the  measles  of  1801,  the  same  eminent  physician  states 
that  the  disease  wore  the  livery  of  the  autumnal  fever  in  the  fol 
lowing  particulars :  "  It  was  strongly  marked  by  remissions  and 
intermissions;  the  exacerbations  came  chiefly  at  night;  there 
was  in  many  cases  a  constant  nausea  and  discharge  of  bile  by 
puking."3 

Dr.  Balfour  tells  us  that  the  intestinal  remitting  fever  of  Bengal, 
of  which  he  has  left  us  a  graphic  account,  often  appeared  with 
symptoms  of  dysentery,  rheumatism,  and  pleurisy.4  In  1777,  Clos- 
sot  observed  yellow  fever  associated  with  putrid  typhus,  and  the 
union  of  two  poisons  in  this  way  was  noticed  by  Pringle  and  others 
in  Europe,  in  the  case  of  typhus  and  marsh  fevers.  The  fever  of 
Banker  Street,  New  York,  in  1820,  was  evidently  a  complication 
of  bilious  remittent  and  typhus — the  idio  koino  miasmal  fever  of 
Dr.  J.  M.  Smith.5 

In  the  epidemic  of  Naples,  in  1764,  it  was  rare,  as  we  learn  from 
Sarcone,  for  other  diseases,  originating  from  causes  different  from 
those  of  the  epidemic  which  scourged  the  city,  not  to  pass  finally 
into  the  latter.6  Loew  remarks  that,  during  the  petechial  fever 
which  prevailed  in  Presburg,  in  1683,  gout,  colic,  and  sporadic  dis 
eases  generally  were  often  confounded  or  blended  with  the  popular 
or  epidemic  fever.7 

Dr.  Blake,  in  his  account  of  the  climate  and  diseases  of  California, 
remarks  that,  although  the  influence  of  malaria  does  not  show  itself 
in  the  Sacramento  Valley,  "  by  producing  any  of  the  more  marked 
forms  of  disease  by  which  its  presence  is  usually  manifested,  yet 
we  have  constant  indications  of  its  existence,  by  the  character  it 
impresses  on  almost  every  form  of  disease  occurring  in  this  lo 
cality."8  The  yellow  fever  which  prevailed  epidemically  at  Tam- 

1  Fever  of  Dominica,  19.  a  Vol.  ii.  235,  iii.  77. 

3  Vol.  iii.  73. 

4  A  Collection  of  Treatises  on  the  Effects  of  Sol-lunar  Influence  in  Fevers,  124,  125. 

5  On  Epidemics,  57.  6  Maladies  cle  Naples,  ii.  59. 
7  Epid.  de  Morbo  Petechiali,  5.  8  N.  0.  Journ.  is.  510,  511. 


460  PNEUMONIA    AND 

pico,  in  1836,  exercised  a  marked  influence  on  all  the  intercurrent 
diseases  which,  in  consequence,  presented  themselves,  clothed  with 
some  of  the  symptoms  of  the  reigning  fever.1  Experience,  indeed, 
everywhere  shows  that  remittent,  intermittent,  and  yellow  fevers 
are  sometimes  engrafted  upon  or  blended  with  smallpox,  scarla 
tina,  measles,  dysentery,  erysipelas,  syphilis,  scabies,  hooping-cough, 
oriental  plague,  cholera,  gonorrhoea,  &c. 

Dr.  ISTepple,  in  his  description  of  an  epidemic  of  periodic  fever 
which  prevailed  in  the  Canton  of  Dombes,  in  France,  in  1823,  states 
that  almost  every  febrile  disease  was  then  attended  with  periodical 
paroxysms,  which  subsequently  degenerated  into  true  intermittent 
attacks.  Bronchitis,  which  was  very  common,  and  of  a  highly 
acute  character  during  the  winter,  became  complicated  with  nervous 
irritations,  spasmodic  dyspncea  of  a  more  or  less  intermittent  type, 
and  with  remittent  paroxysms.  Intermittent  neuralgias  were  more 
than  usually  common.  In  a  word,  every  disease  appeared  to  have 
assumed  a  nervous  and  periodic  character.2 

The  same  phenomenon  was  observed  at  Auch  some  years  later, 
where,  independently  of  intermittent  pernicious  fevers  which  pre 
vailed  extensively,  periodicity  entered  as  an  element  in,  or  as  a 
complication  of  the  greater  number  of  the  intercurrent  diseases, 
even  in  those  which  presented  the  inflammatory  character,  and  in 
which  physicians  were  more  than  once  obliged  to  employ  at  the 
same  time  the  lancet  and  the  sulphate  of  quinia.3 

The  sweating  fever  prevailed  epidemically  in  the  Department  of 
Dordogne,  in  France,  during  the  greater  part  of  the  year  1841, 
affecting  10,803  individuals  in  a  population  of  83,342,  and  causing 
a  mortality  of  797,  or  1  in  about  5.5  of  the  sick.  For  two  years 
previous,  the  Department  (especially  that  part  of  it  embracing  the 
Cantons  of  Nantron,  Kiberac,  and  Perigueux),  was  overrun  with 
eruptive  fevers — measles,  scarlatina,  smallpox,  and  varioloid.  Gene 
rally,  one  or  two  of  these  occupied  the  ground  three  or  four  weeks, 
and  then  made  way  for  the  others.  In  several  instances,  measles 
and  scarlatina,  or  smallpox  and  varioloid,  marched  together ;  while 
in  some,  all  four  existed  at  the  same  time.  Under  these  circum 
stances,  the  sweating  fever  made  its  appearance.  In  the  course  of 

1  Goupilleau,  Kept,  by  Chervin,  Bulletin  de  1'Acad.  in.  308. 

2  Tr.  des  Fievres  Interm.  137. 

3  Campnrdon,  Apei^u  sur  les  Maladies  qui  out  regne  epidemiquement  a  Auch,    Bul 
letin  de  1'Acad.  viii.  Go4. 


AUTUMNAL    FEVERS.  461 

the  year — from  the  7th  of  May  to  November — the  disease  broke 
out  five  times  in  as  many  different  places,  and  disappeared;  so  that 
the  epidemic,  considered  in  its  ensemble,  appeared,  as  it  were,  in  five 
instalments.  On  four  of  these  occasions  it  assumed  suddenly  its 
legitimate  garb,  and  immediately  drove  away  all  other  diseases. 

On  the  fifth,  however,  things  took  a  different  turn.  All  at  once, 
after  a  thunderstorm,  on  the  7th  of  May,  and  the  days  following,  a 
disease  heretofore  unknown  broke  out.  It  was  very  different  in  its 
nature  and  results  from  the  measles,  which  then  prevailed;  but  yet 
difficult  at  first  to  recognize,  owing  to  its  being  under  the  depend 
ence  of  the  complaint  it  so  singularly  and  suddenly  came  to  replace. 
The  disease  no  longer  presented  exactly  the  same  train  of  pheno 
mena,  the  same  kind  of  pulse,  or  eruption.  Nevertheless,  there  was 
in  that  new  physiognomy  of  symptoms  a  family  air  which  greatly 
puzzled  the  physicians.  The  measles  were  modified.  To  the  pre 
cursory  febrile  symptoms  were  added  others  which  are  strangers  to 
the  disease :  while  others  which  belong  to  it  disappeared  unexpect 
edly.  Some  days  before,  the  patients  had  been  seized  with  a  chill, 
cough,  coryza,  and  all  the  opening  symptoms  of  measles.  In  some 
cases,  one  of  these  symptoms  now  gave  way ;  in  others,  a  different 
one  disappeared;  in  all,  the  attack  henceforward  came  on  without 
the  chill.  Some,  however,  had  a  marked  and  well-defined  rubeolic 
eruption ;  while  in  others  the  skin  became  covered  with  a  miliary 
eruption.1  To  this  interesting  fact  may  be  added  another,  somewhat 
akin  to  it,  derived  from  high  authority;  that  Storck  and  Lepecque 
de  la  Cloture  mention  epidemics  of  miliary  fever,  during  which  the 
pneumonias  which  prevailed  terminated,  not  by  expectoration,  but 
by  miliary  eruptions,  more  or  less  abundant,  or  by  fetid  sweats. 

Diseases  arising  from  various  species  of  malaria  mix  together  and 
form  compounds. — Furthermore,  diseases  arising  from  the  opera 
tion  of  malarial  effluvia,  but  having  a  separate  and  independ 
ent  existence,  marked  by  distinct  characters,  and  governed  by 
different  laws,  combine  with  each  other  and  present  groups  of 
phenomena  which,  though  they  have  given  rise  to  considerable 
discussion  and  been  subjects  of  angry  controversy,  must  be  viewed 
as  the  effect  of  such  complications,  and  not  as  mere  modifications 
of  one  and  the  same  disease.  The  amalgamation  of  typhus  with 

1  Parrot,  Histoire  de  la  Suette  Miliaire.     Mem.  de  FAcad.  de  Med.  x.  395,  396. 


462  PNEUMONIA    AND 

intermittent  fevers,  diseases  which,  differ  materially  on  many  points, 
"but  approximate  on  others,  has  been  noticed  in  some  of  our 
Southern  States,  the  cases  exhibiting  clearly  the  symptoms  of 
the  former  disease;  while,  at  the  same  time,  the  type  was  periodic.1 
Dr.  Stoker,  speaking  of  a  number  of  cases  of  ague  he  treated  in 
Dublin,  some  years  ago,  says  that,  "though  the  periodical  revolu 
tions  which  characterize  agues  were  observable  in  these  cases,  still} 
they  were  more  or  less  under  the  debilitating  influence  of  the 
same  epidemic  constitution,  and  also  of  the  same  moral  and  phy 
sical  causes  which  hitherto  prevailed,  and  even  at  the  same  time 
impressed  some  cases  of  fever  with  the  characteristics  of  typhus  in 
an  exquisite  degree."2  A  like  combination  of  true  malignant  yel 
low  fever  with  simple  or  double  tertians,  or  other  varieties  of  peri 
odic  or  autumnal  fevers  of  various  types,  the.  existence  of  which 
was  recognized  and  pointed  out  upwards  of  a  century  ago  by  Pouppe 
Desportes,3  has  been  dwelled  upon  with  more  or  less  emphasis  by 
scores  of  our  contemporaries,  and  of  writers  of  the  preceding 
generation.4  Its  occurrence,  the  assertion  of  a  few  physicians  to 
the  contrary  notwithstanding,  is  indisputable,  and  may  be  cited  as 
a  satisfactory  illustration  of  the  compounds  in  question ;  while  the 
circumstance  of  its  being  overlooked  or  undiscovered  may  be  viewed 
as  one  of  the  principal  causes  of  the  error  committed  by  those  pa- 
thologists  who  regard  the  former  disease  merely  as  a  higher  grade 
of  the  latter. 

During  the  epidemic  of  yellow  fever  at  Tampico  in  1836,  already 
referred  to,  intermittents,  in  particular,  assumed  this  complicated 
form ;  for,  during  the  continuance  of  the  epidemic,  they  almost  in 
variably  presented,  in  addition  to  their  legitimate  symptoms,  one 
or  more  of  those  appertaining  to  the  yellow  fever. 

The  yellow  fever  which  closed  its  epidemic  career  in  Charleston, 
a  year  ago,  was  accompanied  by  and  blended  with  the  breakbone 

1  Du  Pre,  on  the  Antagonism  of  Disease.     Charleston  Journ.  v.  COT,  608. 

2  Pathological  Observations,  pt.  ii.  103. 

3  Maladies  de  St.  Domingue,  i.  230. 

4  Lempriere,  ii.  70;    Osgood,  27,  28;    Imra}T,  Edinb.  Journ.  Ixiv.  337;    Rochoux, 
197;  Nott,  New  Orleans  Journ.  iv.  580;    J.  M.  Smith,  on  Epidemics,  310;    Kelly, 
Amer.  Journ.  N.  S.  xiv.  376 ;  Wood,  Practice,  i.  304 ;  Chisholm,  Letter  to  Dr.  David 
son,  Med.  Repos.  v.  231,  232;  Lewis,  New  Orleans  Journ.  ii.  202,  413;    Id.  iv.  154; 
Id.  v.  40;   Charleston  Journ.  ii.  696;   Dickson,  Essays,  152,  153;   Id.  Trans,  of  Med. 
Assoc.  v.  252;    Barton's  Rep.   30;    Bryson,  70,  84,  1%,  &c.  :    Blair,  70;    Heberden, 
385;  Williams,  i.  303,  302,  464,  625;  Dcsruelle  on  Hooping-cough.  12:  Ilalphen,  1,  &c. 


AUTUMNAL   FEVERS.  463 

fever,  or  dengue,  and  well-marked  eruptions  of  several  varieties — 
pustular,  papular,  and  exanthematic.  The  complication  of  dengue 
with  remittent  and  intermittent  fevers  has  been  noticed  by  Dr. 
Arnold,  of  Savannah,1  and  by  Professor  Dickson,  of  Charleston.2 
The  like  blending  of  remittent  with  typhoid  fever  is  pointed  out 
by  Dr.  Cain  of  the  same  city.3  In  a  clever  article  on  the  Medical 
Topography  of  the  Parish  of  De  Soto,  La.,  Dr.  Gibbs  speaks  of 
cases  of  a  mixed  nature,  which,  u  although  affording  all  the  usual 
indications  of  typhoid  fever,  displayed  likewise  the  so-called  mala 
rial  characters ;  as  evinced  by  the  distinct  intermissions  which  at 
tended  for  several  days,  the  icterode  appearance  of  the  skin  and 
eyes,  and  the  yellow  coating  of  the  tongue,  with  other  symptoms 
of  bilious  derangement."4 

In  Blair  County,  of  this  State,  typhoid  fever  prevailed  exten 
sively  from  the  middle  of  January,  1852,  to  September.  Sporadic 
cases  occurred  in  other  months,  but  the  disease  only  assumed  an 
epidemic  character  during  the  above-mentioned  period.  Dr.  Coffey, 
of  Hollidaysburg,  remarks,  that  the  cases  that  happened  in  the 
summer  and  fall,  resembled  strongly  in  their  commencement  remit 
tent  fever,  and  for  which  the  inexperienced  readily  mistake  them. 
"  Indeed,"  says  the  reporter,  "  the  manifestations  of  this  disease  are 
protean.  It  occasionally  simulates  intermittent  fever."5  Typhoid 
fever  is  on  the  increase  at  Eio  Janeiro,  where,  as  we  have  seen, 
malaria  abounds;  and  we  are  told  by  Dr.  Sigaud,  that  cases  in 
which  the  symptoms  of  the  disease  are  combined  with  those  of 
periodic  fever,  are  very  commonly  encountered.  To  such  an  extent, 
indeed,  does  the  complication  prevail,  that  it  at  one  time  occasioned 
the  greatest  confusion  in  the  minds  of  many  as  regards  the  diagnosis 
of  the  cases,  and  led  to  much  hesitation  respecting  the  proper  treat 
ment  to  be  pursued.6  Similar  complications  of  typhoid  with  inter 
mittent  have  been  noticed  in  France. 

M.  Gauthier  cle  Claubry,  in  his  Eeport  on  the  Epidemics  of  France 
during  the  year  1847,  makes  particular  mention  of  the  wide  preva 
lence  of  typhoid  fever  that  year ;  and  states,  as  the  result  of  observa 
tions  made  in  various  parts  of  the  country,  that  sometimes  the  disease 

1  Charleston  Journ.  vi.  332.  2  Trans,  of  Med.  Association,  v.  145. 

3  Ibid.  358. 

4  Fenner's  Southern  Reports,  ii.  196,  197  ;  see  also  Charleston  Journ.  v.  824. 

5  Trans,  of  Med.  Soc.  of  State  of  Pennsylvania,  iii.  75. 

6  Sigaud,  Climat  et  Maladies  du  Bresil,  252. 


PNEUMONIA    AND 

presented  the  phenomena  of  intermittence  or  rather  of  remittance. 
This  was  often  attributed  to  the  influence  of  accidental  causes,  as 
marshes,  stagnant  waters,  with  the  more  reason,  indeed,  because 
this  modification  in  the  symptomatology  of  the  typhoid  affection 
occurred  only  in  individuals  placed  directly  under  the  influence  of 
some  of  the  above-mentioned  causes,  while  the  inhabitants  of  places 
situate  far  from  marshes  and  stagnant  waters,  presented  only  the 
symptoms  of  ordinary  adynamic  or  ataxic  typhoid  fever.1 

Euecker  long  ago  recognized  the  complications  of  intermittent 
with  malignant  or  typhus  (probably  typhoid)  fever.2  Pringle,  on 
his  side,  regarded  the  morbus  Hungaricus  as  a  compound  of  bilious 
with  hospital  fever;  and  those  who  attentively  examine  the  accounts 
we  have  of  that  disease,  can  scarcely  refuse  to  admit  that  the 
opinion  has  the  appearance  of  being  well  founded.3  Indeed,  it  may 
be  laid  down  as  a  fact  of  general  occurrence,  that  when  typhoid 
fever  breaks  out  in  paludal  localities,  after  intermittents  have  there 
prevailed,  the  cases  are  frequently  of  a  modified  character,  and 
assume  a  periodic  type.  And  surely  he  would  scarcely  be  listened 
to  who  maintained  that  all  the  diseases  here  enumerated,  simply 
because  they  present  themselves  clothed  with  some  or  many  of  the 
symptoms  of  malarial  fever,  or  impart  some  of  their  characteristics 
to  these,  must,  therefore,  be  due  to  the  cause  giving  rise  to  the 
latter,  and  are  really  and  substantially  nothing  more  than  peculiar 
forms  of  one  and  the  same  complaint.  An  intelligent  writer  of  one 
of  our  Southern  States,  after  describing  the  several  forms  of  fever 
of  his  neighbourhood,  remarks,  very  pertinently :  "  Here  are  four 
varieties  of  acute  disease,  peculiar  somewhat  to  certain  terrestrial 
formations.  Can  any  one  possessed  of  candour  and  ordinary  rea 
soning  powers,  examine  into  their  history,  and  fail  to  see  the  strik 
ing  characteristic  differences.  The  enslaved  and  overtasked  mind 
may  reason,  that,  inasmuch  as  they  are  all  fevers  of  the  same  season, 
appearing,  blending,  and  mingling  together,  and  often  running  into 
each  other,  specific  distinctions  cannot  be  made.  To  this  kind  of 
argumentation,  we  may  properly  reply,  that  red,  white,  black, 
green,  are  all  colours.  They  may  be  so  mingled  and  blended,  run 
ning  into  each  other  by  imperceptible  degrees,  as  to  produce 
various  shades,  and  associate  in  the  mind  a  most  intimate  and 

1  Mem.  de  1'Acad.  de  Med.  XT.  12.     Sec  also  vol.  xviii.  107. 

2  De  Feb.  Interm.  Complicatione  cum  Maligna  Casa,  &c. 

3  Diseases  of  the  Army,  188. 


AUTUMNAL   FEVERS.  465 

inseparable  connection ;  yet,  when  they  are  displayed  in  their  pri 
mitive  natural  character,  how  boldly  and  prominently  do  they  con 
trast."1  Each  of  the  diseases  mentioned  exists  at  times,  and,  indeed, 
generally,  independently  of  the  others;  some  are  the  offspring  of 
specific  contagious  poisons,  and  can  in  no  way  possible  arise  from 
the  operation  of  other  causes  producing  different  complaints ;  others 
are  the  offspring  of  non-contagious  poisons;  others,  again,  arise 
from  changes  in  the  sensible  qualities  of  the  atmosphere.  They 
blend  together  in  very  many  ways,  in  their  types  and  characters, 
under  the  conjoint  influence  of  several  concurrent  causes ;  and  if, 
in  their  simple  and  uncomplicated  garb,  they  must  be  held  as 
idiopathic  and  independent  disorders,  they  cannot  cease  to  be  so, 
when,  to  their  own  characteristic  phenomena,  are  added  some  or 
more  of  those  that  appertain  to  malarial  fevers.  Now  all  this 
applies  equally  well  to  those  cases  which  form  more  particularly 
the  subject  of  our  present  inquiries  ;  for  in  the  same  way  that  mala 
rious  fevers  are  sometimes  engrafted  on  typhus,  plague,  &c.,  so  they 
may  be,  and  often  are,  engrafted  on  serous,  mucous,  and  paren- 
chymatous  inflammations,  and  on  that  of  the  substance  of  the  lungs 
among  the  rest.  To  say  that  such  an  occurrence  is  not  possible, 
would  be  equivalent  to  maintaining,  that  a  complication  which 
undeniably  occurs  in  regard  to  many  diseases,  even  to  some  pro 
duced  by  specific  and  contagious  poisons,  cannot  do  so  in  reference 
to  thoracic  inflammations.  I  leave  to  those  who  feel  disposed  to 
hazard  the  assertion,  the  task  of  explaining  the  reason  of  this  ex 
ception.  If  they  succeed,  we  shall  be  forced  to  doubt  the  possibility 
of  the  coexistence  of  other  morbid  poisons  in  the  same  individual ; 
for  the  evidence  on  which  such  coexistences  rest  is  not  a  whit 
stronger  than  that  adduced  in  favour  of  the  complication  of  pneu 
monia  with  malarial  fevers. 

Diseases  due  to  specific  contagious  poisons  amalgamate  together,  or  with 
other  complaints,  and  form  hybrid  complaints,  or  exist  together  in  the 
same  subject. — Disprove  satisfactorily  the  complication  under  con 
sideration,  and  it  will  follow,  that  when  writers,  whatever  be  the  re 
spect  usually  accorded  to  their  opinions  and  statements,  tell  us  of  the 
variolous  poison  being  capable  of  coexisting  with  several  other  poi 
sons — of  its  influencing  their  actions  and  being  reciprocally  influ- 

1  Lewis's  Med.  Hist,  of  Alabama,  N.  0.  Journ.  iv.  165. 
30 


466  PNEUMONIA    AND 

enced  by  them ;  when  they  talk  of  smallpox  existing  in  the  same 
subject  with  scarlatina,  hooping-cough,  measles,  miliary  fever,  psora, 
or  syphilis;  when  they  affirm  that  hooping-cough  and  measles,  the 
vaccine  poison  and  syphilis,  scarlatina  and  measles,  or  scarlatina  and 
hooping-cough  occasionally  combine  together ;  when  they  cite  cases 
in  which  typhus  existed  with  erysipelas,  scarlatina,  vaccinia,  psora, 
syphilis,  or  gonorrhoea ;  when  they  describe  the  plague  as  sometimes 
existing  in  combination  with  smallpox,  vaccinia,  syphilis,  or  cholera 
Asiaticus;  or  of  dengue  uniting  with  scarlatina — influenza  with  the 
latter  disease  or  measles — or  syphilis  with  herpes  or  psora;  when, 
in  addition,  they  inform  us  of  three  distinct  diseases,  as  smallpox, 
measles,  and  hooping-cough;  or  measles,  scarlatina,  and  chicken- 
pox,  running  their  course  simultaneously ;  when  we  are  told  that 
inoculation  with  a  mixture  of  variolous  and  vaccine  matters  will 
produce,  not,  as  Woodville  stated,  one  or  other  of  the  two  dis 
eases,  but  loth;  when  a  case  is  cited  on  the  authority  of  Leroux, 
in  which  the  vaccine  pustule  was,  as  it  were,  imbedded  in  the 
variolous,  and  the  matter  of  each,  when  used  for  inoculation,  pro 
duced  its  specific  disease;  when,  I  say,  they  talk  of  such  occurrences, 
we  shall  be  justified  in  doubting  the  accuracy  of  their  observations, 
and  in  maintaining  that,  instead  of  assemblages  of  distinct  diseases, 
we  have  in  all  such  instances  really  and  substantially  but  one  com 
plaint,  modified  somewhat  by  peculiarities  of  season  and  weather, 
or  other  causes,  but  still  to  all  intents  and  purposes  the  same.1 

All  these  complications — all  this  livery  wearing — all  this  amal 
gamation  of  things  distinct  from  each  other,  is  now  perhaps  too 
well  known,  and  generally  acknowledged,  by  those  whose  attention 
has  been  drawn  to  the  subject,  and  who  are,  in  consequence,  best 
qualified  to  form  an  opinion  upon  it,  to  have  required  any  length 
ened  remarks  in  this  place,  were  it  not  that  some  writers  among  us 
and  elsewhere,  who  are  not  backward  in  severely  criticizing  and  cast 
ing  ridicule  on  the  views  of  physicians  of  high  authority,  and  who 
charitably  undertake  to  set  the  whole  professional  world  right  on 

1  See,  on  these  various  combinations,  Nott,  N.  0.  Journ.  March,  1848,  p.  586;  Dick- 
son,  Trans,  of  Mod.  Assoc.  v.  142,  143;  Williams  on  Morbid  Poisons,  i.  40,  120,  211, 
212,  204,  301,  ii.  38,  65,  191,  206,  623;  Holland,  Connection  of  Diseases,  58,  Am.  ed. 
64;  Blair,  70;  Heberden,  385;  Fodere",  Med.  Legale,  v.  352-357*  Lafont-Gouzi,  Mate- 
riaux  pour  servir  a  1'Hist.  de  la  Medecine  Militaire,  &c.  47-83 ;  Sarcone,  Mai.  de  Naples, 
ii.  225;  Anglada,  Traite  de  la  Contagion,  i.  331,  332,  334,  336;  Adams  on  Morbid 
Poisons,  11,  13;  Bousquet,  Traite  de  la  Vaccine,  300;  Bxtbertson,  a  General  View  of 
the  Nut.  Hist,  of  the  Atmosphere,  ii.  370. 


AUTUMNAL    FEVERS.  467 

knotty  points  of  pathology  and  etiology,  appear  to  have  lost  sight, 
or  to  be  ignorant  of  the  true  explanations  of  the  occurrences 
alluded  to.  If  they  have  forgotten,  they  must  be  reminded,  and  if 
they  do  not  know,  they  cannot  fail  to  be  benefited  by  the  informa 
tion,  that  the  Hunterian  maxim,  which  teaches  that  no  two  different 
fevers  can  exist  in  the  same  constitution1 — a  maxim  from  which  Bar- 
thez  started,  in  establishing  his  doctrine  of  the  distraction  of  forces,2 
and  about  which  so  much  has  been  said — is  unfounded ;  that  though, 
in  most  cases,  one  of  those  diseases  acquires  the  supremacy  over 
the  other,  and  either  expels  it  or  keeps  it  in  check,  in  other  in 
stances,  they  progress  simultaneously;  that  this  takes  place  even 
in  relation  to  eruptive  fevers,  a  fact  denied  by  Hunter ;  and  that 
the  whole  of  what  has  been  remarked  in  the  preceding  pages  is 
conformable  to  certain  laws  which  should  not  be  overlooked  by 
those  who  undertake  to  describe  the  true  and  fundamental  cha 
racters  of  diseases,  and  to  assign  to  these  their  nosological  position. 
When  they  come  to  investigate  the  subject  as  it  deserves  to  be  in 
vestigated,  they  will  find  that  intercurrent,  endemic,  or  even  epi 
demic  diseases,  are  influenced  not  only  by  the  meteoric  constitution 
of  the  period  at  which  they  appear,  but  that  their  characters,  pheno 
menal  and  anatomical,  are  constituted  at  the  outset  of  those  apper 
taining  to  them,  and  also,  to  a  greater  or  less  extent,  of  those 
transmitted  by  complaints  arising  from  anterior  medical  constitu- 
tutions  or  reigning  causes ;  and  toward  the  close  of  their  preva 
lence,  of  those  characterizing  succeeding  complaints.  They  will 
find  that  such  diseases  seldom  manifest  themselves  in  their  pure 
and  unmodified  garb  except  towards  the  middle  of  their  career  of 
prevalence,  when  the  influence  of  anterior  and  succeeding  constitu 
tions  or  morbid  causes  is  not  felt ;  that  what  takes  place  in  the 
same  locality  during  different  periods  occurs  at  the  same  epochs  in 
different  localities — diseases  which  retain  their  purity  of  character 
in  particular  places,  losing  it  as  they  reach  other  places  where  dif 
ferent  morbid  influences  prevail ;  and  that  much  the  same  results 
obtain  in  regard  to  diseases  which  attack  individuals  exposed  to 
other  morbid  influences  elsewhere,  or  in  the  same  place  at  other 
seasons.3 

1  On  the  Blood,  introd.  13.     Am.  ed. 

2  Nouv.  Elem.  de  la  Sc.  de  I'homme,  ii.  181. 

3  See  on  these  subjects  Boudin's  Geographic  Medicale,  22,  and  Fuster's  very  excel 
lent  work,  Des  maladies  de  la  France  dans  leurs  rapports  avec  les  saisons,  193-199. 


468  PNEUMONIA    AND 

"  This  fact,"  as  Dr.  J.  M.  Smith  observes,  "  was  specially  remarked, 
by  Sydenham  and  Hodges,  of  the  disorders  which  preceded  the 
plague  of  London  in  1665.  Similar  instances  are  recorded  by  Bel- 
linus,1  Yan  Swieten,  Bayley,2  and,  indeed,  by  most  writers  on 
pestilential  epidemics.  Dr.  Mead  sums  up  these  facts  in  the  general 
observation,  that  fevers  of  extraordinary  malignity  are  the  usual 
forerunners  of  plagues,  and  the  natural  consequence  of  that  state  of 
air  which  attends  all  plagues.  Part  1,  ch.  I."3 

Pneumonia,  like  other  inflammations,  sometimes  assumes  a  periodic 
type,  independently  of  a  malarial  influence.  —  Most  of  the  instances 
mentioned  are  doubtless  the  effects  of  the  complication  or  blending 
of  distinct  diseases.  But  while  admitting  this  to  be  the  most  proper 
explanation  of  the  amalgamation  of  the  phenomena  they  present,  we 
must  not  lose  sight  of  the  circumstance  that  the  inflammation  of  the 
lungs,  like  other  acute  affections,  has  a  tendency  in  some  cases  to 
assume  a  remittent  or  intermittent  type.  That  such  a  tendency  may 
be  noticed  in  that  disease  is  a  fact  which  we  might  a  priori  con 
clude  ;  for  there  are  but  few  cases  in  which  symptoms  of  febrile 
reaction  do  not  exhibit  a  diurnal  abatement  and  aggravation  more 
or  less  marked,  or  do  not  present  every  second  or  third  day  a  more 
decided  change  of  the  same  kind.  As  stated  on  a  former  occa 
sion,  the  existence  of  a  good  and  bad  day  is  evidently  recognizable 
in  most  cases  of  pneumonia  ;  and  I  presume  it  may  safely  be  averred 
that  a  decided  remission  is  only  a  considerable  diminution,  and  an 
intermission  only  a  temporary  cessation  of  the  morbid  condition 
existing  during  the  abatement  referred  to.  These  remarks  are 
equally  applicable  to  other  inflammations  and  irritations,  where 
soever  they  may  be  seated,  and  by  whatsoever  cause  they  may  be 
produced.  This  tendency  to  decided  remissions  and  intermissions, 
occurs  more  frequently  during  the  prevalence  of  the  cause  of  pe 
riodical  fevers,  which  modifies  the  morbid  process,  and  imparts  to 
it  the  element  of  periodicity,  without,  however,  being  sufficiently 
energetic  in  its  impression,  or  meeting  in  the  system  with  a  suffi 
cient  degree  of  susceptibility,  to  produce  a  decided  attack  of  fever, 
or  even  to  give  rise  to  the  development  of  some  of  the  more  marked 
symptoms  of  the  latter.  But  cases  of  the  kind  have  occurred  when, 


Webster,  ii.  44.  2  Fever  Of  jfew  York,  1795. 

Smith  on  Epidemic,  170,  171. 


AUTUMNAL    FEVEES.  469 

from  the  non-existence  of  periodic  fevers  in  the  vicinity,  it  was 
impossible  satisfactorily  to  refer  the  effect  to  the  agency  of  the 
admitted  cause  of  such  diseases,  and  under  circumstances  which 
precluded  the  supposition  of  its  arising  from  the  development  of  a 
morbid  agent  lying  dormant  in  the  system. 

The  manifestation  of  this  tendency  in  pneumonia  cannot,  there 
fore,  lend  support  to  the  idea  of  identity,  as  regards  causation  and 
nature,  of  that  disease  with  malarial  fevers,  of  which  periodicity, 
partial  or  complete,  constitutes  a  characteristic  element ;  unless  we 
are  prepared  to  assert  that  all  diseases  in  which  we  notice  perfect 
or  imperfect  remissions — whether  observed  in  districts  of  country 
subject  to  malarial  complaints,  or  in  places  totally  free  from  these — 
are  the  products  of  the  same  cause  as  remittent  and  intermittent 
fevers,  and  consequently  really  and  substantially  nothing  more 
than  peculiar  forms  of  these.  From  this  the  strictest  medical  unit- 
arian  will  doubtless  shrink ;  for  he  must  have  seen — or  if  he  has 
not,  others  have — cases  afar  from  any  malarial  influence,  in  which 
irritation  produced  by  mechanical  or  kindred  causes,  has  been 
attended  with,  or  followed  by,  febrile  symptoms  characterized  by 
decided  remissions,  or,  indeed,  intermissions.  Every  one  knows 
that  the  introduction  of  a  bougie  into  the  urethra  has  sometimes 
produced  that  effect.  Bartholin,  Forestus,  Pollini,  Eoederer,  Mon- 
gellaz,  and  others,  relate  cases  of  intermittent  diseases  occasioned 
by  the  irritation  of  intestinal  worms.  Frank  relates,  from  Schmac, 
a  case  of  the  same  kind,  resulting  from  swallowing  a  piece  of  lard. 
Frank  himself  saw  the  same  effect  produced  by  mushrooms.  A 
case  fell  under  my  own  observation,  some  years  ago,  in  which  six 
febrile  paroxysms  were  produced  by  the  ingestion  of  a  peach-stone. 
In  this  instance  there  could  have  been  no  malarial  taint.  Dr.  Evan- 
son,  in  his  work  on  the  Diseases  of  Children,1  mentions  a  case  in 
which  febrile  paroxysms  of  a  remittent  type,  which  lasted  several 
days,  occurred  in  a  child,  from  swallowing  a  marble.  The  symp 
toms  made  their  appearance  soon  after  the  occurrence,  and  were 
suddenly  cured  by  the  expulsion  of  the  irritating  cause.  The  same 
effect  has  resulted  from  the  formation  in  the  stomach  of  a  cheesy 
coagulum,  and  was  cured  by  its  expulsion.2  Dr.  Pascalis  describes 
intermittent  paroxysms  resulting  from  the  irritation  of  decayed 
teeth ;  the  elder  Frank  from  a  gumboil,  &c.  Other  examples  of 

1  P.  243,  Am.  ed. 

2  See  Copland's  Diet  ii.  1120;  Stewart,  Dis.  of  Children,  127. 


470  PNEUMONIA    AND 

the  same  import  might  easily  be  adduced ;  but  the  task  is  unneces 
sary  ;  experience  daily  showing,  that  morbid  irritations,  by  whatso 
ever  causes  produced,  and  in  whatsoever  organic  apparatus  or  system 
of  the  economy  situate,  may,  and  often  do  assume  the  remittent  and 
intermittent  types.  These  are  observed  in  irritation ,  of  the  red 
capillaries,  inflammatory  and  hemorrhagic;  in  sub-inflammatory 
and  nervous  irritations.  Of  all  these,  examples  may  be  found  in 
works  of  easy  access.  In  a  word,  there  are  facts  enough  afloat,  to 
prove  that  the  element  of  periodicity  does  not  belong  exclusively 
to  febrile  diseases  of  a  malarial  origin. 

So  far  from  it,  the  periodical  is  as  much  a  natural  type  as  the  con 
tinued.  It  characterizes  many  of  the  phenomena  of  health,  and  ex 
hibits  itself  in  the  physiological  play — both  as  regards  progress  and 
intensity  — of  many  of  the  functions ;  in  the  processes  of  secretion, 
elimination,  and  calorification ;  in  the  operations  of  the  nervous 
system ;  in  muscular  contraction ;  in  the  action  of  the  heart,  &c. 
Intermittence,  indeed,  may  well  be  viewed  as  an  element  essential 
to  the  existence  of  the  normal  actions  of  the  economy.  What  is 
more,  it  adheres  to  these  actions  in  their  passage  from  the  state  of 
health  to  that  of  disease,  and  may,  therefore,  be  recognized  as  an 
element  of  this  state  also.  It  stands  as  an  illustration  of  the  great 
law  of  periodicity  which  regulates  all  the  vital  movements.  This 
law  has  elicited,  as  we  have  seen,  the  attention  of  medical  and  phy 
siological  observers  from  an  early  period  of  our  science,  and  has 
not  been  neglected  in  modern  times.  An  American  writer,  the  late 
Dr.  Carpenter,  of  New  Orleans,  has,  among  others,  pointed  this 
manifestation  of  intermittence  in  the  functions,  and  after  showing, 
as  Dr.  Lay  cock  had  done  already,  that  the  periodicity  of  these  is 
governed  by  a  power  or  agency  inherent  in  the  system,  and  only  in  a 
secondary  manner  dependent  upon  the  physical  influences  which  sur 
round  us,  properly  remarks:  ''This  principle  once  established,  it  be 
comes  an  easy  matter  to  account  for  the  intermittence  of  disease,  by 
referring  it  to  the  persistent  and  controlling  influence  of  these  phy 
siological  oscillations,  whose  periods  and  intervals  continue  to  mark 
and  measure  its  stages  and  paroxysms.  The  matter  of  surprise  and 
inquiry  will  then  become,  not  why  some  diseases  are  intermittent 
in  their  course,  but  rather,  why  it  is,  that  all  of  them  are  not  so  ?'u 

1  New  Orleans  Med.  Journ.  iii.  423.  See,  on  this  subject,  Bich.it,  Anatomic  Gene- 
rale,  Lois  d'lutermittence,  i. ;  Holland  on  Morbid  Actions  of  Intermittent  Kind, 
Medical  Notes,  193,  Am.  ed. ;  Mongellaz,  Essai  sur  les  Irritations  Intermittents,  vol. 
i.  3-5 ;  X.  A.  Med.  and  Sura;.  Journ.  i.  327. 


AUTUMNAL    FEVERS.  471 

Surely,  when  we  take  all  these  facts  and  circumstances  into  consi 
deration,  we  cannot  but  perceive  the  impropriety  of  concluding, 
from  the  occurrence  of  remissions  and  even  full  intermissions  in 
pneumonia,  that  the  disease  must  necessarily  be  the  offspring  of  the 
cause  whkih  gives  rise  to  periodic  fevers,  and  nothing  more  than  a 
peculiar  form  of  the  latter. 

The  success  of  the  anti-periodic  treatment  in  pneumonia — supposing  it 
true — no  proof  of  the  identity  in  question. — For  these  reasons,  I  am  not 
prepared  to  admit  that,  in  managing  a  case  of  pneumonic  inflamma 
tion,  "we  must  not  lose  sight  of  the  fact  that  we  are  dealing  with 
a  constitutional  disease — with  a  periodic  fever — which  is  to  be  re 
lieved  by  quinia,  or  to  adduce,  from  the  supposed  beneficial  effects 
of  that  remedy  in  the  disease  in  question,  an  argument  in  favour  of 
the  identity  contended  for.  This  argument  may  be  traced  far  back 
in  the  history  of  our  science,  when  every  disease  that  was  cured 
by  bark  was  supposed  to  partake  of  the  nature  of  an  intermittent 
fever — to  be,  in  fact,  only  a  periodic  fever  in  disguise.  The  prac 
tical  advice  above  referred  to  can,  at  most,  apply  to  some  cases  only, 
and  certainly  not  to  all.  In  the  large  majority  of  instances  of  pneu 
monia,  as  observed  everywhere — even  in  very  many  of  those  seen 
in  the  South — the  physician  will  have  no  reason  to  bear  in  mind 
what  Dr.  Merrill  lays  so  much  stress  upon.  The  disease  is  in  no 
way  connected  with  periodic  fever.  It  is  a  constitutional  affection 
in  this  sense  only,  that  the  system  at  large  becomes  implicated  in 
the  morbid  disturbance  by  nervous  and  arterial  reaction.  In  that 
respect  it  is  closely  allied  to  all  other  complaints  in  which  import 
ant  organs  or  tissues  become,  from  some  cause  or  other,  the  seat  of 
inflammation,  and  in  which,  unless  the  powers  of  life  are  crushed, 
from  the  outset,  and  placed  beyond  the  possibility  of  reaction,  febrile 
phenomena  set  in.  Hence,  the  principal  object  in  the  treatment 
will  be,  not  to  cure  the  constitutional  disease,  but  the  local  inflam 
mation  and  its  various  complications ;  because,  on  the  disappear 
ance  of  these,  the  case  will  come  to  an  end.  Supposing,  now,  that 
some  cases  get  well  under  the  use  of  quinia,  the  result  could  not 
prove  the  connection  suggested.  Before  adducing  that  success  for 
the  purpose  in  question,  it  would  be  necessary,  first,  to  demonstrate 
beyond  doubt  the  reality  of  the  benefit  to  be  derived  from  the 
remedy,  or  rather  of  the  superiority  of  the  method  proposed,  if  not 
.the  indispensable  necessity  of  resorting  to  it ;  and  secondly,  to  show 


472  PNEUMONIA    AND 

how,  admitting  the  results  to  be  as  advantageous  and  marvellous 
as  the  warmest  advocates  of  the  method  represent  them  to  be,  they 
can  in  any  way  serve  to  prove  the  dependence  of  thoracic  inflam 
mation  upon  ordinary  periodic  fever. 

Now,  as  to  the  former  of  these  points — the  great  benefit  or  supe 
riority  claimed  for  the  quinia  practice,  when  resorted  to  during 
the  abatement  of  febrile  excitement  in  pneumonia — I  cannot  greatly 
err,  when  expressing  the  opinion  that  many,  very  many  practitioners, 
in  all  parts  of  the  world,  who  have  seen  much  of  the  disease,  and 
acquired  the  needful  skill  in  its  management,  will  feel  no  disposi 
tion  to  join  in  singing  the  praise  of  that  method,  or  to  adopt  it  to 
the  exclusion  of  the  one  they  have  heretofore  employed.  They 
will  say,  and  I  suspect  that  statistical  returns  will  bear  them  out  in 
the  assertion,  that  while  autumnal  fevers,  especially  when  they 
assume  the  truly  periodic  type,  call,  in  some  of  their  stages,  for  the 
use  of  anti-periodics,  and  more  particularly  of  quinia,  it  is  very 
far  from  being  proved  that  the  same  will  hold  good  with  regard 
to  pneumonia  and  kindred  thoracic  inflammations,  which  are,  to  say 
the  least,  cured  just  as  well  without  as  with  the  aid  of  the  salts  of 
bark;  that  in  their  usual  form  they  yield  to  antiphlogistics,  gene 
ral  and  topical,  and  to  revulsives,  or  even,  in  some  instances,  to  the 
powers  of  nature;  that,  in  the  majority  of  cases,  the  quinia  prac 
tice  would  be  not  only  useless  but  hazardous,  and  should  on  this 
account  be  avoided ;  that,  as  a  general  rule,  the  remedy,  if  used  at 
all,  can  only  be  so  after  other  means  of  a  different  or  opposite  kind 
have  been  resorted  to ;  and  that,  when  these  have  been  properly 
timed  and  judiciously  employed,  the  disease  seldom  requires  the 
aid  of  tonics,  still  less  of  those  possessing  an  anti-periodic  power. 
They  will  say,  besides,  that  when  tonics  are  called  for,  it  is  not  in 
virtue  of  their  anti-periodic  effects;  that  as  much  advantage,  if  not 
more,  is  derived  from  other  articles  of  the  materia  medica;  and 
that,  when  the  disease  assumes  the  typhoid  form,  it  may  be  more 
successfully  treated  by  local  depletions  and  revulsives,  or  by  the 
latter  without  the  former,  together  with  stimulating  diaphoretics  and 
expectorants,  and  sometimes  with  stimulants  and  tonics.  Finally, 
they  will  say  that,  when  the  latter  are  required  or  admissible,  quinia 
will  often  answer  a  good  purpose ;  but  that  it  is  doubtful  whether 
it  will  bo  more  serviceable  than  other  articles  •  of  the  materia 
medica.  In  all  this,  the  majority  of  professional  men  throughout 
this  country  and  in  Europe  will,  I  have  little  doubt,  acquiesce. 


AUTUMNAL    FEVERS.  473 

In  these  parts,  where,  I  should  presume,  the  treatment  of  pneu 
monic  inflammation  is  as  well  understood,  and  as  successful,  as  it 
is  in  any  other  section  of  the  world,  I  feel  confident  that  few  physi 
cians  of  note  would  be  disposed,  from  experience,  to  resort  to  quinia 
or  other  kindred  remedies  at  any  but  the  last  period  of  the  disease, 
or  when  signs  of  prostration  or  relaxation  of  the  powers  of  life 
manifest  themselves.  But  in  such  instances  they  would  prescribe 
it  on  very  different  principles  from  those  advocated  by  Dr.  Merrill ; 
and  I  think  it  might  be  shown  that  the  same  sentiment  is  enter 
tained  elsewhere,  even  in  the  very  section  of  country  where  he  has 
acquired  the  larger  share  of  his  experience. 

To  this  it  may  be  added,  that  the  claim  set  up  in  latter  times  for 
quinia,  of  being  a  powerful  and  pure  counter-stimulant  or  sedative 
— especially  when  administered  in  large  doses — an  opinion  which, 
originating  in  Italy  some  thirty  years  ago,  has  received  the  support 
of  several  French,  English,  and  American  physicians,1  is  not,  after 
all,  sufficiently  authenticated,  so  far,  particularly,  as  relates  to  dis 
eases  produced  by  causes  different  from  ordinary  malarial  exhala 
tions,  to  justify  a  resort  to  the  remedy  in  the  treatment  of  pneu 
monia  so  long  as  signs  of  inflammatory  irritation  exist.  Admitting, 
therefore,  that  all  we  have  heard,  and  continue  to  hear,  concerning 
the  manifestation  of  that  property,  and  of  the  wonderful  effect  result 
ing  from  it  in  periodic  fevers,  of  all  possible  grades,  types,  and 
forms — to  say  nothing  of  dozens  of  other  complaints,  the  number  of 
which  seems  to  enlarge  with  every  succeeding  writer,  in  some  sec 
tions  of  our  country — were  placed  beyond  the  possibility  of  doubt, 
the  fact  would  not  help  those  who,  from  a  supposed  similarity  of 
effect  of  certain  remedies  in  certain  diseases,  venture  the  conclusion 
that  those  diseases  are  similar;  for  it  is  yet  to  be  proved,  by  correct 
clinical  observations,  that  quinia  exhibits  that  property,  and  is  re 
markably  successful  in  pneumonia.  Nay,  more,  supposing  these 
wonderful  effects,  both  as  regards  the  latter  disease  and  malarial 

1  Bailly,  Traite  des  Fievres  In  term.  1825,  p.  424  ;  Guersant,  Diet,  de  Mdd.  xxvi.  564 ; 
Geromini,  Annali  Univ.  de  Med.,  March.  1841;  Blair,  107;  Drake,  746  ;  Bell's  Lec 
tures,  ii.  782 ;  Boling,  Am.  Journ.  N.  S.  viii.  89 ;  Fenner,  New  Orleans  Journ.  v.  208 ; 
Id.  9,  318,  &c. ;  Id.  Southern  Reports,  ii.  849  ;  McCormick,  New  Orleans  Journ.  ii.  175  ; 
Holmes,  A.  J.,  N.  S.,  xii.  304;  Merrill,  New  Orleans  Journ.  viii.  161,  163;  Upshur, 
Stethoscope,  ii.  437 ;  McCaw,  Stethoscope,  ii.  666,  &c.  ;  Desiderio,  Comptcs  Rendus 
de  1'Acad.  des  Sciences,  ix.  509;  Bally,  J.  Gen.  do  Med.  Oct.  18,  1829,  p.  7;  Me>at 
et  Delens,  Diet,  de  Mat.  Med.  v.  607  ;  Jacquot,  Arch.  Gen,  1845,  vi.  76  ;  Briquet, 
Traite  Therapeutique  du  Quinquina,  21,  42,  107,  123. 


474  PNEUMONIA    AND 

complaints,  to  be  such  as  they  are  represented  in  certain  quarters; 
supposing  that  quinia  is  a  decided  sedative;  that  it  is  a  perfectly 
harmless  remedy ;  that  by  its  means  fevers  may  be  cut  short  at  the 
outset;  supposing  that  it  may  be  safely,  and,  indeed,  beneficially 
employed  in  large  and  repeated  doses  throughout  the  attack  of 
these  diseases,  or  before  the  complete  cessation  of  febrile  reaction, 
and  that  analogous  effects  may  be  expected  to  result,  and  are  ob 
tained,  in  pneumonia,  it  is  difficult  to  perceive  how,  from  these 
circumstances,  a  proof  of  the  identity  of  this  disease  with  fever  can 
be  derived. 

Not  only  does  the  success  of  quinia  in  the  latter  fail  to  indicate 
that  the  same  result  must  necessarily  attend  the  employment  of  the 
remedy  in  pneumonia,  but  success  in  both  complaints  would  lend 
no  help  to  the  advocates  of  the  identity  in  question.  In  the  first 
place,  no  fault  can  be  found  with  those  who  in  the  present  state  of 
the  question  at  issue,  are  skeptical  as  to  the  wonders  related  of 
quinia,  and  feel  disposed  to  question  the  propriety  of  administering 
very  large  doses  of  it  at  the  commencement  of  a  febrile  attack, 
without  waiting  for  a  marked  remission,  and  especially  during  the 
continuance  of  high  arterial  action  and  symptoms  of  local  inflam 
mation  or  irritation ;  for,  after  all,  this  practice,  for  which  Dr.  Dun- 
das1  claims  credit,  but  for  which  the  profession  in  this  country  was 
long  before  his  time  indebted,  some  say  (for  this  important  point, 
if  important  it  really  be,  has  not  yet  been  satisfactorily  settled,  there 
being  several  claimants  in  the  field)  to  Dr.  Thomas  Fearn,2  of  Ala 
bama  ;  others  to  Dr.  Metcalf,3  of  Miss. ;  and  some,  again,  to  Dr.  Per- 
rine,4  of  the  same  State ;  this  practice,  I  say,  though  it  enumerates 
warm  and  respectable  advocates  both  on  this  and  the  other  side  of 
the  Atlantic,5  cannot  be  said  with  certainty  to  have  proved,  in  the 

1  Sketches  of  Brazil,  287,  291,  &c.  2  Fenner's  Southern  Reports,  ii.  346. 

3  Id.  i.  352.  4  Amer.  Journ.  xi.  250. 

5  Drake,  Western  J.  xi.  ;  Ib.  Dis.  £c.  of  the  Valley,  &c.  775,  789 ;  May,  Transyl. 
J.  x.;  Van  Buren,  Examiner,  1846;  Upsher,  ib. ;  Maillot,  Fievres  Interm.  11,  140, 
362;  Broqua,  M6m.  sur  le  Sulf.  de  Quinine,  Bulletin,  vi.  619,749;  viii.  624  ;  Fletcher, 
Med.  Times  and  Gaz.  April  23,  1853,  p.  422;  Ib.  Braithwaite,  pt.  xxvii.  264,  Am  ed.  ; 
11.  Gee  and  W.  Eddowcs,  Lancet,  Sept.  1853,  p.  210,  Am.  cd.  ;  Cummins,  ib.  218; 
Sigaud,  Climat  et  Maladies  du  Bre"sil,  245;  Briquet,  Trnite  Therapeutique,  339,  358, 
366;  Tuck,  N.  0.  J.  ii.  303;  Mitchell,  ib.  iii.  16;  Merrill,  ib.  viii.  161;  Fenner,  ib.  v. 
209;  Ib.  ix.  318;  Ib.  Southern  Med.  Rep.  i.  118;  Ib.  ii.  98;  McCraven,  N.  0.  J.  v. 
234;  McCormick,  N.  0*  J.  ii.  173;  Coolidge,  South.  Med.  Rep.  ii.  449;  Haspel,  Mai. 
tie  1'AlgeYie,  ii.  332,  &c. ;  Manson,  Stethoscope,  iii.  135. 


AUTUMNAL   FEVERS.  475 

hands  of  every  good  and  safe  practitioner,  as  advantageous,  except 
perhaps  under  exceptional  circumstances,  as  its  originators  and 
partisans  so  confidently  assert. 

To  whomsoever  the  bright  idea  may  have  suggested  itself  among 
us,  the  practice  is  evidently  but  a  revival  of  the  one  suggested  and 
resorted  to  as  early  as  the  close  of  the  seventeenth  century,  by 
Morton  —  adopted  not  long  after  by  Torti,  Burserius,  Werlhof, 
Trnka,  and  other  physicians  of  the  times,  and  highly  eulogized, 
so  far  at  least  as  regards  its  applicability  to  yellow  fever,  by 
Arejula,  Sarravia,  Lafuente,  Bobadilla,  and  the  majority  of  Spanish 
physicians,  as  well  as  by  Valentin,  Cassan,  Lefoulon,  Guyon,  Sava- 
resi,  Stevens,  Kuhn,  &c. — of  administering  the  Peruvian  bark  in  the 
largest* possible  doses,  in  all  stages  of  the  disease,  after  little  prepa 
ration,  or  without  any  preparation  at  all ;  and  we  all  know  that  the 
success  obtained  from  it,  though  satisfactory  in  a  few  cases,  has  not 
been  such  as  to  encourage  its  general  adoption.  The  theoretical 
views  upon  which  the  practice  was  predicated  were,  doubtless,  some 
what  different  from  those  by  which  the  advocates  of  the  quinia 
treatment,  above  referred  to,  are  guided ;  but  the  effects  claimed  are 
similar.  Forget  for  a  moment  that  the  writers  cited  are  speaking 
of  cinchona,  and  not  of  quinia,  and  you  may  fancy  that  the  latter 
remedy  is  the  subject  of  their  remarks.  Upon  the  administration 
of  a  large  dose,  it  was  said,  the  pulse  is  reduced ;  the  skin  cools 
and  moistens;  thirst,  if  it  existed,  disappears;  the  tongue  becomes 
clean  and  moist;  in  a  word,  fever  disappears  as  by  enchantment; 
arid  if  the  patient  experience  a  little  uneasiness  about  the  head,  a 
little  dizziness,  perhaps  a  slight  buzzing  in  the  ears,  the  whole  soon 
subsides,  and  convalescence  follows.  Such  were  the  effects  claimed 
for  bark,  in  the  class  of  disease  in  which  the  quinia,  used  in  the 
way  mentioned,  is  said  to  act  as  by  magic.  Is  not  the  fate  of  the 
former  practice  calculated  to  raise  some  doubts  as  to  the  perma 
nence  of  reputation  of  the  latter? 

Let  it  be  said,  en  passant,  that  experience  will  doubtless  one  day 
demonstrate,  to  all  whose  eyes  are  not  blinded  by  theory,  that  more 
noise  has  recently  been  made  about  the  abortive  plan  of  treating 
febrile  diseases  by  means  of  scruple  or  even  larger  doses  of  quinia, 
given,  with  or  without  preparation,  at  the  outset  of  the  attack,  with 
the  intention  of  arresting  their  progress,  than  is  warranted  by  the 
nature  of  the  results  obtained.  Entitled  as  the  authority  of  many 


476  PNEUMONIA    AND 

of  the  advocates  of  the  plan  may  be  to  our  respect,  it  may  be 
fairly  suspected  that,  in  singing  its  praise  so  loudly,  and  pro 
claiming  its  superiority  over  every  other  heretofore  pursued,  they 
have  allowed  their  imagination  to  get  somewhat  the  better  of 
their  judgment.  To  this  conclusion  I  am  the  more  inclined,  be 
cause  it  is  yet  to  be  proved  that  remittent  and  yellow  fevers,  when 
once  established,  can  be  arrested  in  their  course ;  and  the  practice 
has  failed,  and  even  proved  detrimental,  in  the  hands  of  other 
observers,  so  far  especially  as  regards  the  yellow  fever.1  Besides 
this,  several  of  its  more  zealous  advocates  would  extend  the  prac 
tice  to  every  other  form  of  fever  named  in  the  books — typhus, 
typhoid,  &c. — in  which,  when  resorted  to  by  other  equally  skilful 
physicians,  in  this  country  and  elsewhere,  quinia,  as  an  abortive, 
sedative,  or  specific,  has  failed  to  produce  the  anticipated  effect,2 
unless  perhaps  the  disease  had  assumed  a  decidedly  remittent  or 
intermittent  type,  when  it  required  no  prophet  to  tell  us  it  would 
be  useful.  It  is  true  that,  by  the  warm  supporters  of  the  plan  in 
question,  no  heed  is  taken  of  the  opposition  it  has  encountered ; 
but  on  inquiry  we  cannot  find  that  any  stronger  reason  has  been 
assigned  (and,  taking  all  things  into  consideration,  it  cannot  but 
appear  extraordinary  that  something  better  could  not  have  been 
offered)  for  the  failure  experienced,  even  with  what  might  well  be 
regarded  as  classical  doses  of  the  panacea,  than  that  physicians  who 
recount  their  ill  success  would  have  obtained  opposite  results  had 
they  only  given  the  quinia  a  fair  trial ;  in  other  words,  adminis 
tered  it  earlier  and  in  larger  quantities.  To  those  who  have  no 
hobbies  to  ride,  the  fact  of  these  repeated  failures,  to  say  nothing  of 
certain  analogies  they  may  bear  in  mind,  and  sundry  theoretical 
views  they  may  entertain  respecting  the  pathology  of  the  disease, 
and  the  mode  of  operation  of  the  remedy,  will  be  sufficient  to 
deter  them  from  joining  in  the  hosannas  sung  in  some  quarters; 
while  the  allegation  that  southern  and  western  physicians,  who,  we 
should  think,  cannot  be  accused  of  over-timidity  in  the  use  of  remc- 

1  Stone,  N.  0.  J.  ii.  184,  &c.  ;  Dickson,  Charleston  J.  i.  14;  Lewis,  N.  0.  J.  i.  425, 
427;  Ib.  iv.  174;   N.  0.  J.  x.  279;   Furlonge,  Lancet,  Dec.  1853,  p.  441,  Am.  ed.     In 
this  city,  last  .autumn,  the  quinia  practice  failed  completely. 

2  Gibbs,  Former,  ii.  ;   Bolirig,  N.  0.  J.  ix.  2,  £c.  ;   Maggibbon,  N._  0.   J.  x.   25,  36; 
Scruggs,   N.  0.  J.  x.   206;   Gordon,   ib.   146,   210;   Fletcher,    Braithwaite's  Abstract, 
July,  1853,  p.  204 ;  Grant,  Am.  J.  sxvi.  (N.  S.)  104  ;  Barclay,  Mcd.  Times,  Jan.  8,  53. 


AUTUMNAL   FEVERS.  477 

dial  agents — witness  the  history  of  calomel,  tartar  emetic,  and  the 
lancet,  among  them — have  not  been  struck  with  the  success  of  the 
abortive  method,  simply  because  they  had  not  been  heroic  enough 
with  quinia,  which  the  most  cautious  among  them  daily  use  in 
doses  which  cause  astonishment  in  excellent  and  skilful  practitioners 
elsewhere,  will  appear  passing  ludicrous,  and  may  recall  to  their 
minds,  as  it  has  done  to  mine,  a  certain  passage  in  Gil  Bias,  in 
which  the  great  Sangrado — the  worthy  prototype  of  more  than  one 
physician  of  an  era  not  very  remote  from  our  own — accounts  for 
the  loss  of  the  Canon  Sedillot,  whom  he  had,  as  a  matter  of  course, 
bled  profusely  and  deluged  with  warm  water.  I  quote  the  original : 
"  Comme  il  rendaitles  derniers  soupirs  le  medecin  parut,  et  demeura 
un  peu  sot,  malgre  1'habitude  qu'il  avait  de  depecher  ses  malades. 
Cependant  loin  d'imputer  la  mort  du  chanoine  a  la  boisson  et  aux 
saignees,  il  sortit  en  disant  d'un  air  froid  qu'on  ne  lui  avait  pas  fait 
tirer  assez  de  sang  ni  fait  boire  assez  d'eau  chaude."1 

I  am  aware  that  the  experiments  of  Bricquet  and  others  show, 
that  the  sulphate  of  quinia,  when  given  in  doses  of  fifteen  grains  or 
upwards,  has  a  tendency  to  reduce  very  considerably  the  frequency 
and  force  of  the  circulation ;  and  that  a  similar  effect  is  also  obtained 
in  lower  animals,  whether  the  remedy  be  administered  by  injection 
into  the  vessels,  by  the  stomach,  or  by  insertion  into  the  cellular 
tissue.2  I  am  aware,  also,  that  this  depressing  action  of  quinia 
has  been  very  frequently  observed  in  this  country  and  in  Europe.3 
But  while  we  admit  all  this,  and  feel  convinced,  besides,  that  many 
physicians,  among  us  especially,  have  heretofore  been  too  timid  in 
the  administration  of  the  article,  have  used  it  in  too  small  doses, 
and  postponed  it  too  long ;  that  it  is  better  to  give  it  in  a  few  smart 
doses,  than  in  small  and  repeated  quantities ;  and  that,  in  some 
cases,  it  is  tolerated,  and  has  produced  excellent  effects  in  very  large 
doses ;  nevertheless,  it  is  impossible  to  shut  our  eyes  to  the  fact 

1  Liv.  ii.  chap.  ii. 

2  Comptes  Rendus  des  Seances  de  1'Acad.  des  Sci.  xxvii.  549 :  Ib.  Reflexions  sur 
1'emploi  du  S.  de  Q.  a  hautes  doses,  Bulletin,  viii.  898 ;  Ib.  Traite  Therapeutique,  &c. 
21,  42. 

3  Briquet.   Traite   Therapeutique  du  Quinquina,   21,  42,  &c. ;  Bally  and  Banquier, 
J.    Gen.   de  Med.   Oct.    1829,  p.  7  ;    Jacquot,   Arch.   Gen.    1845,   vi.   76  ;    Lambert, 
Essai  sur  la  Methode  Endermique,  97  ;    Guersant,  Repertoire  des  Sc.  Med.  art.  Quin 
quina ;  Legroux,  Journ.  de  Med.  et  de  Chir.  Pratiques,  April,  1845:  Boucher,  Sur 
1'emploi  du  S.  de  Q.  dans  la  Fievre  Typhoide.     These,  1846.     See  others,  mentioned 
above,  at  p.  173. 


478  PNEUMONIA    AND 

that  this  sedative  action  does  not  always  manifest  itself;  that 
quinia  not  unfrequently  increases  the  force  and  activity  of  the  cir 
culation  ;  that  when  the  sedation  is  produced,  it  is  for  the  most  part 
secondary,  and  akin,  as  Guersant,  McCaw,  and  others  remark,  to 
that  occasioned  by  overpowering  portions  of  alcoholic  or  other 
stimulants,  or  to  the  after  effect  of  lesser  doses  of  these ;  that  it  is 
preceded  by  a  stage  of  reaction — in  short,  it  may  be,  but  too  evident 
to  be  denied — that  when  produced,  the  depression  of  the  circulation 
is  obtained  at  the  expense  of  the  brain  and  nervous  system  (of 
which  it  is  far  from  being  a  true  sedative),  and  of  the  gastric  and 
sometimes  the  entire  mucous  membrane,  on  which  it  operates  as  an 
irritant ;  that  in  ordinary,  if  not  in  all  diseases,  the  existence  of 
inflammation  is  generally  found  by  physicians  entitled  to  the  fullest 
credit,  to  prove  a  bar  to  its  production,  and  that  this  morbid  condi 
tion  is  apt  to  be  aggravated  by  the  free  use  of  the  remedy.  All 
this  is  so  evident,  that  we  may  venture  the  remark  that  experience 
will,  before  a  very  long  while,  prove,  to  the  satisfaction  of  all  candid 
observers,  that  those  who  carry  the  vaunted  abortive  plan  to  the 
extent  recommended ;  those  who  use  quinia  in  very  large  doses, 
without  regard  to  the  existence  of  inflammation,  and  prescribe  it 
as  well  during  the  exacerbation  of  febrile  complaints  as  during  the 
apyrexia,  run  the  risk  of  doing  much  mischief;  that  they  are  re 
commending  a  method  of  treatment  very  far  from  being  calculated 
to  lessen  the  ratio  of  mortality ;  that  of  the  cases  which  appear 
to  have  been  greatly  benefited,  or  cured  by  the  use  of  quinia  given 
in  the  heroic  way  mentioned,  not  a  few  have  got  well  in  spite  of 
the  treatment;  that  others  are  seriously  injured  by  it,  or  receive 
the  seed  of  much  subsequent  mischief;  and  that,  of  those  who  suc 
cumb  under  the  plan  in  question,  many  might  have  had  a  better 
chance  of  recovery  if  treated  in  a  different  way. 

The  supposition  must  appear  the  more  natural,  when  we  reflect 
that  more  than  enough  may  be  gathered  from  experiments  insti 
tuted  in  England,  France,  Italy,  and  this  country,  as  well  as  from 
clinical  observations  made  by  most  reliable  authorities  in  all  parts 
of  the  world,  to  demonstrate,  beyond  the  possibility  of  doubt,  that  the 
sulphate  of  quinia  possesses  toxical  properties  of  no  inconsiderable 
power,  and  sufficiently  glaring  to  prevent  all  prudent  physicians  from 
trifling  with  it,  and  from  using  it,  without  absolute  necessity,  in  the 
enormous  doses  resorted  to  by  a  few  French  and  Italian  practi 
tioners,  but  more  particularly  in  certain  parts  of  this  country;  often 


AUTUMNAL    FEVERS.  479 

without  the  most  remote  regard  to  the  idiosyncrasy  of  the  patient, 
to  the  condition  of  the  stomach  or  bowels,  and  to  other  circum 
stances  of  like  importance.  Let  the  reader  turn  to  the  results  of 
experiments  on  dogs  and  other  animals,  and  he  will  find  that,  when 
given  in  large  doses,  quinia  has  occasionally  produced  stupor,  dilated 
pupils,  coma,  convulsions,  and  death ;  and  that  dissection  in  such 
cases  has  revealed  congestion  of  the  brain  and  its  membranes,  and 
a  fluid  state  of  the  blood.  What  is  more  to  our  present  purpose, 
the  experiments  of  Magendie,  Melier,  and  others  exhibited,  besides 
the  phenomena  mentioned,  signs  of  congestion  of  the  lungs  during 
life,  and  complete  hepatization  of  these  organs  after  death.1  Turn 
ing  to  the  human  species,  we  find  that  much  mischief  has  sometimes 
resulted  from  the  same  remedy.  Cases  could  here  be  referred  to, 
in  which  an  active  quinia  treatment,  pursued  with  the  view  to  cure 
what  was  supposed  to  be  obscure  remittent  fever,  gave  rise  to  sun 
dry  and  very  distressing  nervous  symptoms,  which  it  required  much 
time  to  eradicate.  I  have  now  in  my  mind  a  case  of  that  kind  of 
fever,  treated  in  strict  accordance  with  the  rules  of  the  method  in 
question,  by  one  of  its  most  zealous  and  experienced  advocates,  and 
with  which  I  became  conversant  in  the  South ;  in  which  the  patient, 
although  she  recovered  from  the  disease,  had  a  tedious  conva 
lescence,  and  remained  for  years  a  martyr  to  the  effects  of  extra 
quiniaism.  The  remedy,  when  administered  in  large,  sometimes  in 
moderate,  doses,  has  given  rise,  besides  tinnitus  aurium — its  usual 
attendant — to  agitation,  headache,  vertigo,  subsultus  tendinum,  deli 
rium,  coma,  hasmaturia,  frequent  micturition,  dysuria,  amaurosis, 
deafness,  gastralgia,  gastro-enteritic  inflammation,  diarrhoea,  epileptic 
symptoms,  extreme  prostration,  paralysis,  loss  of  speech,  uterine 
hemorrhage,  numbness  and  coldness  of  the  surface,  echymosis,  pe- 
techias,  &c. 

In  all  this,  I  am  fully  borne  out  by  the  results  of  the  experi 
ments  of  Briquet,2  already  referred  to,  of  Bennet,3  Melier,4  Deside- 
rio,5  Greromiiii,6  Baldwin,7  and  others.  Thus,  the  experiments  of 
Desiderio  show  that  quinia,  when  given  in  large  doses,  produces 
drowsiness,  a  difficulty  of  keeping  the  erect  posture,  a  tendency  to 

1  Melier,  op.  tit.  720,  729.  2  Op.  cit.  xxvii.  549. 

3  Edinb.  Monthly  J.  Jan.  1852;  Am.  J.  Oct.  18o2,  p.  491. 

4  Mem.  de  1'Acad.  de  Med.  x.  722.  * 

5  Comptes  rcndus  de  1'Acad.  dcs  Sciences,  xx.  370.  6  Op.  cit. 

7  Am.  J.  (X.  S.)  xiii.  292.     See  also  Pereira,  Mat.  Med.  ii. ;  Laiicet,  xxxix. 


480  PNEUMONIA    AND 

immobility,  dimness  of  vision,  and  a  dropping  of  the  eyelids. 
Acetate  of  morphia  and  alcohol,  when  given  in  suitable  doses  (the 
size  of  these  differing  according  to  the  kind  of  animals  experimented 
upon),  produce  effects  analogous  to  those  resulting  from  quinia,  and 
when  administered  in  cases  in  which  the  latter  has  been  freely 
given,  add  their  effects  to  those  occasioned  by  the  other.  On  the 
other  hand,  distilled  laurel-water  produces  effects  of  a  contrary  kind, 
and  may,  to  a  certain  extent,  be  considered  as  an  antidote  to  qui 
nia.  Bleeding  is  still  more  efficacious  in  that  respect.  Powdered 
digitalis  appeared  to  produce  analogous  effects.  The  experiments 
of  Briquet  himself,  upon  which  stress  has  been  laid  by  the  advocates 
of  the  heroic  quinia  practice,  prove  that,  when  thrown  into  the 
bloodvessels,  the  remedy  produces  cerebral  excitement,  and  gene 
rally  convulsions.  When  it  penetrates  the  brain  in  an  indirect 
manner,  there  is,  first,  a  certain  amount  of  general  agitation;  then 
follow  debility,  headache,  vertigo,  tinnitus  aurium,  and  paralysis  of 
the  acoustic  nerves,  intolerance  of  vision,  burning  sensation  in  the 
orbits,  weakness  of  sight,  dilatation  of  the  pupils,  and  blindness, 
numbness  of  the  skin  of  the  face,  subsultus  tendinum,  trembling  of 

'  O 

the  limbs,  an  appearance  of  intoxication;  then  a  general  collapse 
and  loss  of  muscular  power,  diminution  or  cessation  of  pain  in  cases 
of  neuralgia.  Autopsy  reveals  injection  of  the  large  vessels  of 
the  pia  mater,  slight  sandy  injection  of  the  substance  of  the  brain, 
and  sometimes  meningitis. 

The  same  experiments  establish  the  fact  that  quinia  produces  an 
hypera3mic  or  engorged  state  of  the  lungs.  In  small  doses  it  ex 
cites  the  lining  membrane  and  secretory  organs  of  the  mouth,  pro 
duces  salivation,  and  increases  the  appetite  and  digestive  powers. 
When  given  in  large  quantities,  and  persevered  in  for  some  time, 
it  sometimes  produces  inflammation  of  the  mucous  membranes; 
and  gives  rise  to  vomiting,  colic,  diarrhoea,  and  all  the  phenomena 
of  gastritis  and  enteritis  in  a  mild  degree.  The  urinary  organs  suffer 
irritation,  as  manifested  by  pain,  frequent  desire  to  make  water, 
hsematuria,  dysuria,  and  even  retention  of  urine.  In  women,  the 
free  use  of  the  article  not  unfrequently  gives  rise  to  uterine  hemor 
rhage.  In  men,  small  doses  excite  the  sexual  organs,  while  large 
and  frequently  repeated  doses  produce  reverse  effects.  The  skin 
is  benumbed  and  cpoled,  and  spotted  over  with  ecchymoses  and 
petechia3.  While  doing  all  this — while  producing  these  various 
morbid  changes  in  the  tissues  and  organs,  quinia  affects  the  compo- 


AUTUMNAL  FEVERS.  481 

sition  of  the  blood,  which,  according  to  many,1  it  notably  defibrinates, 
and  renders  fluid,  dark,  and  incoagulable;  or,  as  would  appear  to 
result  from  the  numerous  experiments  and  observations  of  Briquet,2 
it  renders,  on  the  contrary,  richer  in  fibrin;  and  it  would  not 
be  difficult  to  point  out  instances  in  which,  when  pushed  to  what 
certain  physicians  in  our  country  would  regard  as  safe  and  even 
moderate  closes,  it  has  caused  death,3  not  only  in  animals  experi 
mented  upon,  but  in  the  human  species. 

With  these  facts  before  us,  it  cannot  be  deemed  improper  to 
suggest  the  necessity  of  abstaining  from  administering  the  remedy 
in  larger  doses  than  are  strictly  necessary  to  insure  its  specific 
effect — which  effect,  in  fevers,  especially,  is  due  not  so  much  to  the 
sedative  as  to  the  purely  antiperiodic  property  it  possesses.  ,  That 
this  property,  which  the  advocates  of  sedation  have  often  con 
founded  in  theory  with  the  latter  is  real,  will  not  be  denied  by 
those  who  have  seen  quinia  stop  intermittent  fever  without  pro 
ducing  any  apparent  effect  on  the  system,  save  a  little  buzzing  of 
the  ears.  In  the  next  place,  it  is  not  improper  to  suggest  the  pro- 
prietv,  as  a  general  rule,  of  desisting,  except  in  cases  of  extreme 
emergency,  from  the  use  of  it  during  the  continuance  of  high  febrile 
excitement,  and  especially  during  the  existence  of  well-marked  local 
inflammation,  and  of  reserving  it  for  the  period  when  by  other 
means  an  abatement  or  removal  of  these  have  been  obtained;  or 
for  those  instances  in  which  the  disease  assumes  a  congestive  or 
pernicious  character,  and  must  be  put  a  stop  to  at  all  hazard.  Let 
it  not  be  forgotten  that  some  of  the  most  decided  believers  in  the 
sedative  property  of  quinia,  who  are  friendly  to  its  use  in  large 
doses  in  fevers — intermittent  and  remittent — and  have  tried  it  on  a 
large  scale,  are  decidedly  opposed  to  its  employment  in  those  dis 
eases  whenever  the  surfaces  with  which  it  comes  in  contact — the 
mucous  membranes  of  the  stomach  and  bowels — are  in  a  state  of 

1  Magoudie,  Lecons  sur  les  Phenomenes  Physiques  cle  la  Vie ;  Melier,  Mdm.   de 
1'Acad.  de  Med.  x.  725,  Sic. ;  Giacomini,  Annali  Universal!  de  Medicina,  March,  1841 : 
Baldwin,  Am.  J.  xiii.  (N.  S.)  290;  Guersant,   Diet,  de  Med.  xxvi.  5G7 ;  Bulletin  de 
1'Acad.  de  Med.  viii.  905;  Bonora  and  Arvedi,  Ann.  Univ.  de  Medieina,  March,  1843, 
.juoted  by  Melier;  Monneret.  Mem.  sur  le  S.  de  Q.  a  haute  dose,  June  27,  1843;  Le- 
groux,  op.  tit. 

2  Traite  Therapeutique,  &c.  82,  £c. 

3  Depuisaye,  Examinateur  Med.  15th  Feb.  1843,  quoted  by  Melier,  733;  Briquet, 
Journal  de  Med.  de  M.  Bean,  quoted  by  Melier  :  Piedagnel,  communicated  to  Melier, 
Baldwin,  op.  cit.  293.  299;  Guersant,  op.  tit.  508. 

81 


482  PNEUMONIA    AND 

inflammation.  Among  these  may  be  mentioned  Briquet  himself, 
who  not  only  found,  in  his  experiments,  that  this  substance  occa 
sionally  produces  an  inflammatory  irritation  of  those  tissues,  but 
noticed  that  it  invariably  occasions  injurious  effects  whenever  the 
above-mentioned  parts  are  already  inflamed.  Hence,  he  advises  the 
discontinuance  or  omission  of  the  quinia  in  all  diseases  in  which 
those  membranes  are  so  affected.  And  as  this  condition,  or  at  least 
a  morbid  state  of  irritation  approximating  to  it,  obtains  very  com 
monly  at  some  period  of  remittent,  and  is  not  unfrequently  encoun 
tered  during  the  exacerbation  of  intermittent  fevers,  we  may  under 
stand  that,  in  the  opinion  of  the  great  apostle  of  sedation  himself, 
the  use  of  quinia  is  very  frequently  contra-indicated  in  those  dis 
eases,  and  certainly  should  not  be  resorted  to  indiscriminately,  and 
without  due  regard  to  the  condition  of  gastro-intestinal  surfaces.1 

Be  this,  however,  as  it  may,  as  regards  autumnal  fevers  gene 
rally;  considering — what  every  one  knows — that,  more  than  any 
other  remedy,  quinia  finds  a  useful  application  in  such  fevers ; 
admitting,  for  the  sake  of  argument,  that  it  really  exercises  a  seda 
tive  action  in  them;  that  it  may  be  both  safely  and  advantage 
ously  administered  in  large  doses  during  the  exacerbation;  and 
that  the  inflammation  which  accompanies  malarial  diseases  is  so 
modified  by  the  poison  that  the  system  is  enabled  to  tolerate,  with 
comparative  impunity,  large  doses  of  the  medicine,  nothing  of  the 
kind  can  be  affirmed  in  regard  to  ordinary  inflammations — that  of 
the  lungs  among  them ;  if  not  in  a  special  manner.  In  these,  qui 
nia,  in  the  hands  of  skilful  observers,  has  not  usually  been  found  to 
exercise  the  pure  sedative  effect  in  question ;  and  so  far  from  gene 
rally  proving  beneficial,  it  has  often,  when  administered  during  the 
force  of  the  febrile  excitement,  exasperated  the  disease.  Such  is  the 
case  when  quinia  is  given  in  the  usual  quantities;  and  surely,  we 
have  no  reason  to  believe  that  the  system,  in  such  cases,  is  under 
the  influence  of  a  modifying  agency  capable  of  placing  it  in  a  con 
dition  to  tolerate  the  medicine  in  the  large  and  indeed  immense 
doses  we  occasionally  hear  of. 

It  would  be  the  height  of  impropriety,  therefore,  to  argue,  from 
the  real  or  supposed  benefit  of  quinia  in  autumnal  fevers,  that  the 
remedy  will  be  equally  useful  in  pneumonia;  and  to  conclude,  from 
this  similarity  of  effects,  that  the  two  diseases  are  identical  in  nature 

1  Trait^  Therapeutiquc,  &c.  205. 


AUTUMNAL    FEVERS.  483 

and  causation,  and  that  pneumonia  is  only  a  particular  form  of 
periodic  fever.  The  impropriety  of  the  conclusion  will  appear  the 
more  evident;  because,  while  quinia  is  of  immense  benefit  in 
periodic  fevers,  and  may,  as  some  aver,  be  "used  safely  in  them 
during  the  existence  of  fever,  or  even  inflammation,  it  is  found 
that  it  not  only  acts  injuriously  in  pneumonia,  but,  when  given  in 
large  doses,  has  at  times  exhibited  a  tendency  to  produce  the 
evil  we  wish  to  remove.  On  this  subject,  the  facts  mentioned 
by  Melier  (733,  734),  and  Baldwin  (xiii.  299),  can  leave  no  doubt ; 
while  the  reality  of  the  tendency  might,  in  the  absence  of  those 
facts,  have  been  foreseen  from  the  results  obtained  on  dogs  and 
other  animals,  and  to  which  reference  has  already  been  made. 
Nor  is  it  less  certain  that  the  use  of  quinia  in  pneumonia  has  been 
discarded  or  its  benefit  doubted,  even  by  some  of  the  strongest 
advocates  of  its  sedative  action,  and  of  its  employment  in  the 
exacerbation  of  autumnal  fever.  Dr.  Boling  says:  "As  an  anti 
phlogistic  remedy  in  elevated  and  healthy  localities  (i.  e.  in  which 
the  disease  is  not  complicated  with  or  modified  by  malarial  fever), 
it  will  probably  never  supersede  the  lancet,  &c.,  though  it  may,  in 
many  cases,  be  brought  to  their  aid."1  "  It  may  be  administered," 
says  Dr.  Upshur,  "during  the  intensity  of  the  febrile  paroxysm,  but 
not  if  the  fever  is  the  result  of  pneumonia  and  arachnitis ;  and  the 
physician  who  should  give  quinia  in  these  diseases,  to  reduce  the 
pulse,  because  he  had  seen  it  produce  such  an  effect  in  remittent 
fever  or  rheumatism,  would  commit  a  great  blunder."2  Not  differ 
ent  is  the  opinion  of  Dr.  Lewis,  of  Mobile,3  and  other  physicians  of 
the  South,  who  use  quinia  only  in  cases  requiring  tonics  and  stimu 
lants,  and  shun  it  in  truly  inflammatory  pneumonia. 

A  still  later,  and  very  intelligent  Southern  medical  writer — a 
strong  advocate  of  its  use  in  the  active  stage  of  remittent,  inter 
mittent,  and  continued  fevers — Dr.  McCaw,  of  Eichmond,  Va.,  re 
marks  :  "  Quinia  does  not  apply  itself  to  the  cure  of  inflammation 
of  a  local  character.  It  is  not,  in  my  opinion,  an  antiphlogistic  at 
all."  "I  know  that  some  of  the  quininists  do  say  that  it  is  of  great 
use  as  a  sedative,  even  in  this  class  of  diseases.  I  do  not  think  so 
myself.  I  have  not  found  it  so,  certainly.  I  have  given  it  many 
times  during  the  progress  of  pneumonia  and  pleurisy ;  complicated 

1  American  J.  viii.  110.  2  Stethoscope,  ii.  437. 

3  N.  0.  J.  iv.  174;  ii.  629. 


484  PNEUMONIA    AND 

witli  intermittent  and  remittent  fever,  I  have  always  seen  it  cure 
the  complication,  but  never  the  inflammation.  In  truth,  the  short 
stimulating  stage  of  the  remedy  would  possibly  add  to  the  inflam 
mation,  but  that  its  special  influence  over  the  accompanying  fever, 
stopping  the  daily  paroxysms  of  congestion  which  must  be  so  per 
nicious  to  the  favourable  termination  of  the  disease,  amply  repays 
you  for  this  slight  mischief."1  "  Notwithstanding  the  opinion  of 
contra-stimulists,"  says  a  high  authority,  "  it  is  admitted  by  unpre 
possessed  physicians,  that  Peruvian  bark  (and  its  salts)  aggravates 
pare  acute  inflammation,  and  it  is  hurtful  in  almost  every  paren- 
chymatous  and  membranous  inflammation.  It  aggravates  pneu 
monia  and  gastro-enteritis  with  regular  fever.  It  is  not  less  injuri 
ous  in  inflammatory  diseases  farther  removed  from  the  centre  of 
the  circulation,"2  &c. 

Briquet  himself,  who  as  much  as  any  one  has  insisted  upon,  and 
endeavoured  to  prove  by  experiment  on  animals,  and  the  results  of 
clinical  observation,  the  sedative  action  of  the  quinia,  and  the  neces 
sity  of  using  it  in  all  febrile  diseases,  to  moderate  the  action  of  the 
heart  and  arteries,  acknowledges,  in  his  very  recent  volume  on  the 
therapeutic  employment  of  the  remedy:  1st,  that  the  coexistence 
of  a  large  proportion  of  fibrin  in  the  blood,  or  that  of  a  severe 
inflammation  of  the  membranes,  and  especially  of  the  parenchyma, 
exercise  on  the  heart  an  influence  which  the  sedative  property  in 
question,  administered  in  safe  doses,  cannot  neutralize ;  2d,  that  the 
administration  of  quinia,  given  in  doses  sufficiently  large  to  insure 
its  sedative  effects  on  the  circulation,  produces  in  the  economy  a 
sufficiently  serious  perturbation  to  induce  us  to  avoid  the  risk  of 
it,  in  cases  in  which,  from  the  severity  of  the  disease,  it  becomes 
urgent  to  put  a  stop  to  it.3 

The  only  instances  of  pneumonia  in  which  quinia  has  been  found 
undeniably  and  decidedly  useful  for  the  purposes  contended  for,  are 
those  in  which  the  periodic  element  is  marked  by  well-defined  remis 
sions,  or  complete  intermissions,  and  the  malarial  complication  is 
clearly  exhibited.  It  matters  not  whether  these  intervals  be  of  long- 
duration,  and  exhibit  the  quotidian  or  tertian  types,  or  whether 
the  exacerbation  or  paroxysm  return  after  a  few  hours,  or  even  a 
single  hour  of  repose — a  phenomenon  which  we  know  to  occur  in 

1  Stethoscope,  ii.  070.  f,71.  *  Cuersant,  Diet,  de  Mod.  xxvi.  -384. 

3  On.  cit.  110. 


AUTUMNAL    FEVERS.  485 

other  forms  of  diseases.1  In  these,  and  in  every  other  case  in 
which  this  periodic  element  is  manifest,  quinia  should,  undoubtedly, 
be  resorted  to,  more  especially  when  the  disease  displays  a  per 
nicious  or  malignant  tendency — a  circumstance  which  renders  the 
recurrence  of  a  paroxysm  of  the  utmost  danger.  These  cases,  in 
which  the  inflammation  is  in  all  probability  modified  by  the 
malarial  taint,  in  such  a  way  as  to  tolerate  the  use  of  remedies, 
which,  under  other  circumstances,  could  not  be  borne  with  impu 
nity,  resist  every  other  mode  of  treatment.  They  cannot  be  cured 
by  antiphlogistics  alone ;  for  although  by  these  the  inflammatory 
affection  of  the  lungs  may,  if  uncombined,  be  removed,  the  malarial 
fever  or  taint  is  not  to  be  so  destroyed  ;  and  the  recurrence  of  every 
paroxysm  or  exacerbation,  has  the  effect  of  aggravating  the  local 
disease;  which  cannot,  therefore,  be  eradicated,  unless  a  stop  be  put, 
by  anti-periodic  remedies,  to  the  complicating  complaint.  With 
the  cessation  of  the  latter,  the  pneumonic  inflammation,  if  it  has 
not  reached  beyond  the  first  stage,  generally  disappears  also.  In 
other  cases,  it  abates  considerably,  as  indicated  by  an  improvement 
in  the  general  symptoms  and  physical  signs.  In  others,  again,  it 
continues.  When  this  occurs,  it  must  be  treated  by  the  usual 
means.  But  these  cases,  which,  as  already  said,  are  generally,  if 
not  universally,  the  product  of  a  malarial  influence  superadded  to 
the  ordinary  cause  of  the  disease,  afford  us  examples,  not  of  simple 
pneumonia,  but  of  positive  complications  of  this  disease  with 
periodic  fever,  or  of  its  modification  through  the  agency  of  the 
febrile  poison.  As  a  natural  consequence,  they  are  rarely,  if  ever, 
encountered  in  our  large  cities,  or  in  very  many  places  where, 
though  pneumonia  prevails  extensively,  the  malarial  poison  is  not 
evolved,  or  exercises  its  baneful  influence  with  little  force,  and 
during  a  short  period  of  time  only.  On  the  other  hand,  they  are 
of  frequent  occurrence  in  miasmatic  regions  generally,  and  nowhere 
more  so  than  in  our  Southern  and  Southwestern  States,  where  the 
quinia  has  consequently  been  used  successfully.  It  cannot  be 
surprising,  therefore,  that  Dr.  Farrar  should  remark,  in  his  medical 
topography  of  Jackson  (Miss.):  "In  this  climate,  a  stage  will 
usually  be  seen  in  pneumonia,  when  quinia  may  be  used  with 
freedom  and  efficiency,  which  for  some  years  past  has  been  my 
experience."2  Others  have  written  or  spoken  to  the  same  effect. 

1  Melier.  Mom.  de  1'Acad.  de  Mod.  x.  551. 

2  Fenner's  Southern  Reports,  i.  357. 


4:86  PNEUMONIA    AND 

But  in  such  cases,  I  repeat,  we  are  not  to  recognize  pure,  but  com 
plicated  and  modified  pneumonias. 

In  them,  the  disease  receives,  by  virtue  of  its  association -with 
malarial  fever,  the  periodic  type  by  which  the  latter  is  character 
ized,  and  is  benefited  by  quinia,  not  in  consequence  of  the  sedative 
or  contra-stimulant  action  of  this  remedy  on  the  local  disease  and 
the  system  at  large,  but  of  the  anti-periodic  power  it  possesses,  and 
by  which  it  is  enabled  to  arrest  the  progress  of  the  malarial,  or 
periodic  and  complicating  fever.  The  older  physicians  used  bark 
freely  in  such  cases,  a  point  upon  which  the  reader  may  refresh  his 
memory  by  referring  to  the  writings  of  Torti,  Morton,  Lauter,  Ali- 
bert,  Mongellaz,  Gouraud,  as  well  as  to  an  essay  on  intermittent 
irritations,  published  in  form  of  a  review  in  an  early  volume  of  the 
North  American  Medical  and  Surgical  Journal,  by  the  author  of  the 
present  volume.  "There  is  no  one  among  us,"  says  Sarcone,  "who 
is  not  in  a  condition  to  present  numerous  observations  respecting 
the  happy  results  obtained  by  cinchona  in  affections  of  the  lungSj 
combined  with  periodic  fever.  Messrs.  Serao,  Yentapane,  Rubertis, 
Cinque,  Visoni,  and  others,  have  effected  memorable  cures  with 
bark  in  diseases  of  the  same  nature,  not  only  this  year  (17 64),  but 
also  in  the  preceding  ones.  I  myself,  though  confessedly  young 
in  the  profession,  and  of  little  importance  in  comparison  with  men 
of  eminent  talents,  such  as  those  I  have  had  the  honour  to  name, 
am  able  to  adduce  numerous  examples  of  the  useful  employment 
of  that  remedy  in  the  diseases  in  question."1  The  use  of  quinia  in 
the  same  disease  is  universally  resorted  to.  I  have  myself  em 
ployed  it  largely  by  the  mouth  or  rectum,  and  have  seen  it  em 
ployed  by  others  both  at  home,  in  the  south  of  this  country,  and  in 
Italy,  where  instances  of  the  kind  are  not  uncommon.  Of  course,  it 
is  a  matter  of  indifference  whether  the  inflammation  be  in  the  lungs 
or  elsewhere.  Whenever  it  assumes  a  decidedly  remittent  or  an 
intermittent  type,  and  is  blended  with  a  malarial  fever,  or  modified 
by  a  malarial  taint,  and  more  particularly  whenever  signs  of  malig 
nancy  or  congestion  manifest  themselves,  quinia  should  be  resorted 
to,  and  that  promptly.  We  must,  as  is  well  remarked  by  Dr.  Mer 
rill,  take  advantage  of  the  first  remission,  otherwise  we  may  expect 
the  second  exacerbation  to  become  more  violent  than  the  first;  an 
effect  due,  in  part,  to  the  fact  that  every  violent  paroxysm  of  fever — 

1  Maladies  de  Naples,  i.  212. 


AUTUMNAL    FEVERS.  487 

more  particularly  when  preceded  by  a  chill — tends  to  aggravate 
the  local  inflammation  or  congestion,  and  prostrate  the  nervous 
power.  Be  this,  however,  as  it  may,  cases  such  as  have  just  been 
alluded  to,  are  in  a  great  measure  exceptional,  and  their  occurrence, 
as  well  as  the  treatment  they  call  for,  proves  nothing,  so  far  as  re 
gards  ordinary  and  uncomplicated  pneumonia,  in  which  the  quinia 
practice  would  stand  but  little  chance  of  proving  useful.  Now  this 
practice  being  found  inapplicable  to  the  greater  number  of  cases  of 
pneumonic  and  other  inflammations,  of  doubtful  necessity  in  other?, 
and  only  decidedly  important  in  a  comparatively  few  instances  of  the 
disease — and  those,  too,  in  which  the  periodic  type  evidently  arises 
from  the  complication  or  modification  mentioned — the  argument 
founded  on  the  success  or  superiority  of  the  mode  of  treatment  in 
question  in  pneumonia  cannot  be  sustained;  for  that  usefulness  or 
superiority,  as  regards  the  disease  generally,  is  very  far  from  being, 
as  yet,  proved.  The  first  postulate  must,  therefore,  be  abandoned. 
As  to  the  second — that  the  success  of  quinia  in  pneumonia  must 
be  viewed  as  a  sure  proof  that  this  disease  is  identical  with,  and 
constitutes  only  a  particular  form  of  periodic  or  autumnal  fever,  in 
the  treatment  of  which  that  remedy  is,  if  not  a  specific,  at  least  a 
most  efficacious  remedy ;  it  need  only  be  remarked  that,  even  Avere 
we  disposed  to  recognize  the  validity  of  the  claims  set  up  in  favour 
of  quinia  in  all  instances  of  pneumonia,  it  would  be  illogical  to 
deduce  from  that  superiority  a  proof  of  the  identity  in  question. 
As  every  one  knows,  quinia  is  daily  used  advantageously  in  dis 
eases  which  owe  their  origin  to  causes  very  different  from  the  legiti 
mate  poison  of  autumnal  fevers,  and  which,  nevertheless,  it  is  not 
probable  any  one  would  be  disposed  to  regard  as  constituting  really 
and  substantially  anything  more  than  particular  forms  of  those 
fevers.  In  articular  rheumatism,  arising  without  malarial  taint, 
and  having  nothing  in  the  world  in  common  with  autumnal  fevers, 
it  has  been  and  is  employed  by  Briquet  and  others,  with,  as  it  is 
said,  great  utility.  No  one  but  Dr.  Macculloch  will  be  inclined  to 
maintain  the  intimate  and  constant  dependence  of  neuralgia  upon 
intermittent  fever,  and  to  regard  it  as  being  produced  exclusively  by 
malaria,  That  it  is  often,  as  remarked  by  Dr.  Drake  (863),  the  con 
sequence  of  autumnal  fevers,  especially  when  it  assumes  the  periodic 
type,  no  one  will  deny.  But  it  is  also  found  to  be  the  consequence 
of  other  complaints  in  no  way  allied  to  such  fevers ; — cases  occur 
ring  and  assuming  the  intermittent  character  under  circumstances 


488  PXEUMOXIA    AXD 

which  forbid  the  idea  of  any  malarial  agency.  Nevertheless,  quinia 
is  often  beneficially  employed  in  the  various  forms  of  that  painful 
disease. 

Whatever  be  the  cause  of  periodicity  in  a  disease,  or  rather  what 
ever  be  the  nature  and  cause  of  a  disease,  which  presents  a  well- 
marked  remittent  or  intermittent  character,  quinia  will  be  found 
a  useful  remedy  in  its  treatment.  It  is  useful  also  in  certain 
nervous  disorders  in  which  the  periodic  element  does  not  manifest 
itself,  and  which  have  no  more  to  do  with  periodic  fever  than  with 
smallpox  or  syphilis  ;  and  if  we  conclude  that  pneumonia,  generally, 
is  really  and  substantially  nothing  more  than  a  peculiar  form  of 
remittent  and  intermittent  fever,  and  should  take  its  appropriate 
place  (in  company  with  pleurisy,  &c.)  under  the  plain  designation — 
periodic/ever,  on  the  ground  that  certain  cases  of  it  are,  under  par 
ticular  circumstances,  and  at  a  particular  period  of  their  course, 
greatly  benefited  or  arrested  by  quinia;  if  with  Dr.  Forry,  and 
others,  we  admit  that  the  subjection  of  these  diseases  to  the  same 
remedies  which  are  found  to  arrest  the  course  of  the  one,  also 
arrests  the  course  of  the  other,  "  implies  a  close  alliance,  if  not  a 
common  origin;"1  we  shall  be  led  to  conclude,  also,  that  all  the 
other  disorders  in  which  it  may  be  useful — wheresoever  the  locality, 
and  at  whatsoever  season  they  may  show  themselves — are  of  ma 
larial  origin ;  and  must,  in  like  manner,  take  their  appropriate 
place  under  the  same  plain  designation.  Such  a  mode  of  reasoning 
would  lead  us,  if  we  wish  to  be  consistent,  to  pathological  deduc 
tions,  at  which  our  good  sense  must  revolt,  and  which  would  ill 
accord  with  the  principles  of  the  inductive  philosophy  so  dear  to 
some  of  our  opponents.  ISTo  one  will  deny  that  mercury  is  the 
remedy  for  syphilis;  for  although,  in  the  days  of  our  infatuation  for 
the  Broussaian  doctrine,  many  practitioners  denied  the  necessity  or 
propriety  of  that  remedy,  and  attributed  to  it  a  thousand  evils, 
experience  has  shown,  and  no  less  an  authority  than  Ricord  main 
tains,  that  it  is  superior  to  every  other  means,  especially  in  the  first 
stage  of  the  disease,  and  that  in  many  cases  it  cannot  be  superseded 
by  any  other.  But  mercury  is  found  very  useful,  and  even  indis 
pensable  in  various  complaints:  in  hepatic  and  other  glandular 
derangements;  in  inflammation  of  the  serous  membranes  of  the 
abdomen,  chest,  and  head  ;  in  sundry  diseases  of  the  eye  ;  iritis,  for 

1  Op.  dt.  185,  180. 


AUTUMNAL    FEVERS.  489 

example.  It  is  useful  also  in  various  other  inflammations  and  en 
gorgements,  and  even  in  some  forms  of  periodic  and  malignant 
fevers.  Surely,  we  shall  look  in  vain  for  a  pathologist  disposed  to 
conclude  that  the  benefit  derived  in  these  latter  diseases  from  mer 
cury  indicates  their  identity  with,  or  dependence  on  syphilis,  of 
which  mercury  must  be  viewed  as  the  specific.  If  such  an  admis 
sion  cannot  be  entertained — if  we  acknowledge  that  the  advantages 
derived  from  mercury,  in  the  diseases  mentioned,  in  no  way  justify 
a  belief  in  the  identity  of  these  with  syphilis,  it  is  difficult  to  per 
ceive  the  propriety  of  viewing  pneumonia  as  nothing  more  than  a 
particular  form  of  periodic  fever,  on  the  plea  that  quinia  may  prove 
useful  when  resorted  to  at  the  period  of  remission.  The  second 
limb  of  the  argument,  founded  on  treatment,  must,  therefore,  like 
the  first,  be  set  aside. 

The  hypothesis  of  the  identity  of  pneumonia,  with  autumnal  fever 
not  supported  by  facts  and  solid  arguments.  —  But  it  is  scarcely 
necessary  to  pursue  the  subject  any  farther.  If  what  has  been 
said  is  correct,  neither  the  symptoms  observed  during  life;  the 
anatomical  characters  revealed  after  death  in  pneumonia  and 
autumnal  fevers ;  the  treatment  found  useful ;  the  mode  of  pro 
gression  of  those  diseases;  the  localities  in  which  they  prevail; 
the  external  agencies  by  which  they  are  influenced,  nor  any  other 
point  to  which  I  have  adverted,  afford  any  support  to  the  belief 
of  their  being  pathologically  identical,  or  of  their  arising  from 
the  same  cause.  The  theory  under  examination  must,  therefore, 
fall  to  the  ground,  and  those  who  uphold  it  stand  chargeable  with 
having  ventured  on  a  hasty  and  illogical  conclusion.  Indeed,  they 
have  built  up,  not  a  theory,  but  simply  an  hypothesis,  resting  on 
mere  assumptions  and  conjectures.  I  say  assumptions;  for  we  look 
in  vain  in  the  writings  of  those  who,  discarding  generally  received 
opinions,  have  revived  the  hypothesis  in  question,  for  any  facts  or 
arguments  calculated  to  sustain  the  position  therein  assumed.  Thus, 
we  are  told  by  Dr.  Merrill,  in  a  passage  already  quoted,  that,  ac- 
according  to  his  observations,  "  the  pneumonias  which  prevail  in 
this  country  generally — sometimes  sporadically,  and  frequently  as 
an  epidemic — are  really  and  substantially  nothing  more  than  a 
peculiar  form  of  remittent  and  intermittent  fever."  In  another 
page  the  writer  says :  "  Let  us  talk  as  learnedly,  and  refine,  dis 
criminate,  and  vary  our  nomenclature  as  we  may,  to  suit  the  fash- 


490  PNEUMONIA   AND 

ion  of  the  times ;  when  we  come  to  deal  witli  plain  facts,  as  they  are 
presented  to  us  in  practice,  this  whole  class  of  diseases,  to  which  I 
have  here  alluded  (pleurisy,  pneumonia,  &c.),  will  be  found  to  take 
its  appropriate  place  under  the  plain  designation,  periodic  fever." 
This  fever,  it  is  maintained,  is  a  general  disease,  affecting  the  whole 
system;  but  this  general  disease  probably  never  exists  without 
evincing  a  strong  determination  of  diseased  action  to  some  par 
ticular  organs.  If  the  brain  be  particularly  implicated,  the  disease 
assumes  the  shape  of  phrenitis ;  if  the  stomach,  we  have  gastritis ;  if 
the  liver,  hepatitis ;  if  the  lungs,  pneumonia,  &c.  All  this,  and 
much  more  of  the  same  tenor,  is  affirmed  as  matter  of  fact.  The 
decision,  as  it  would  seem,  is  without  appeal ;  and  all  who  refuse  to 
acquiesce  in  it,  run  great  risk  of  being  stigmatized  as  having  re 
mained  behind  the  times.  But  no  pains  is  taken — no  attempt 
made — to  substantiate  the  particular  opinions  thus  thrown  out. 
Nothing  is  offered  in  their  support ;  nothing  calculated  to  show  that 
the  writer,  who  has  hazarded  them,  is  right,  and  all  who  have  enter 
tained,  or  continue  to  entertain  different  sentiments,  are  wrong. 
So  far  from  it,  we  discover  nothing  but  the  bare  statement;  nothing 
having  the  most  distant  appearance  of  proof;  nothing,  certainly,  so 
far  at  least  as  I  have  been  able  to  discover,  which  may  be  viewed 
in  the  light  of  solid  or  plausible  argument,  based  on  correct  and 
accurately  observed  facts,  and  calculated  to  satisfy  sound  patho- 
logists  and  etiologists.  For  it  cannot  be  supposed,  after  all  that 
precedes,  and  in  the  present  state  of  professional  opinion  relative  to 
the  reality  and  frequency  of  complications,  arising  from  the  co- 
agency  of  two  or  more  distinct  and  independent  causes,  and  of  the 
successive  evolution  of  separate  diseases,  that  we  shall  admit,  as  a 
sufficient  proof  of  the  identity  contended  for,  the  circumstance  that 
in  some  cases  the  symptoms  of  pneumonia  are  combined  with  a 
greater  or  less  number  of  those  of  periodic  or  malignant  fever,  and 
vice  versa;  that  pneumonia  coexists  with,  or  succeeds  to,  these 
fevers ;  and  that  when  the  affection  of  the  lungs,  owing  to  such  a 
complication,  or  to  some  other  morbid  agency,  assumes  the  remit 
tent  or  intermittent  type,  quinia  will  be  found  an  appropriate 
remedy. 

Let  it  not  be  said,  in  proof  of  the  unity  of  all  febrile  diseases— 
the  thoracic  and  other  inflammations  included — and  of  the  identity 
of  their  efficient  cause,  that  writers  draw  a  line  of  distinction  be 
tween  two  cases  of  disease,  in  which  no  one  can  detect  the  slightest 


AUTUMNAL   FEVEES.  491 

difference  while  they  are  in  progress.  Let  us  not  be  told,  by  our 
opponents,  that  "it  may  be  a  good  employment  for  students  in  medi 
cine  to  learn  the  distinctive  character  of  each  variety  so  invented 
and  described,  but  when  we  approach  the  bedside  of  the  sick,  we 
find  it  difficult  enough,  and  useless  enough,  to  designate  the  precise 
nosological  position  to  which  each  particular  case  belongs."  As 
suredly,  the  thrust  here  made  at  medical  writers  cannot  have  refer 
ence  to  the  distinction  they  may  point  out  between  pneumonia  and 
periodic  fever;  for  it  is  scarcely  possible  to  suppose  that  any  one 
who  has  attended  one  month  to  clinical  studies  could  confound  them 
together  so  far  as  regards  their  phenomenal  and  anatomical  characters. 
Allusion  must  be  made  to  the  line  of  distinction  drawn  between  the 
various  forms  of  fevers  themselves.  Now,  I  take  upon  myself  to 
answer,  that  though  some  writers,  as  Copland,  may  have  been 
guilty  of  too  much  refinement  in  their  subdivisions  of  fevers,  the 
fault  is  not  universal;  that  in  writings  of  deserved  reputation,  no 
greater  number  of  varieties  of  that  class  of  disease  is  admitted  than 
can  be  proved  to  have  an  independent  existence;  and  that,  so  far 
from  there  being  any  reason  to  conclude  that  there  is  not  the 
slightest  difference  discoverable  during  the  progress  of  cases  be 
tween  which  writers  draw  the  line  in  question,  it  is  ten,  nay,  a 
hundred  to  one,  that,  when  an  identity  between  such  cases  is  affirmed 
to  exist,  by  the  ordinary  run  of  physicians,  in  opposition  to  the 
opinion  of  professional  writers  of  admitted  experience,  and  who, 
while  having  at  their  command  the  means  of  investigating  the  sub 
ject  on  a  sufficiently  ample  scale,  and  in  all  its  branches,  are  well 
trained  in  the  art  of  conducting  such  an  investigation,  the  cause  of 
the  opposition  is  to  be  found,  not  in  the  fact  that  the  latter  are 
really  at  fault,  but  in  the  inattention,  carelessness,  theoretical  pre 
possessions  or  limited  knowledge  of  the  individual  who  undertakes 
to  pronounce  an  opinion  on  the  nature  and  proper  nosological  posi 
tion  of  the  cases  placed  before  him. 

The  science  of  diagnosis  is  far  from  being  one  of  the  easiest  to 
master.  Indeed,  the  more  we  proceed  in  the  study  of  it — the  more 
we  investigate,  analyze,  and  compare  the  distinctive  features  of 
diseases,  their  pathognomonic  phenomena,  their  points  of  analogy 
and  dissimilarity — the  more  satisfied  must  we  become,  that  it  is  not 
every  physician  who  can  safely  be  entrusted  with  the  task  of  dis 
criminating  between  the  various  forms  of  febrile  complaints,  pro 
perly  so  called ;  especially  if  these  present,  as  they  sometimes  do, 


492  PNEUMONIA    AND 

phenomena  of  a  somewhat  approximative  character,  or  blend  with 
each  other  in  the  way  already  mentioned.  Errors  are  often  com 
mitted,  especially  at  the  outbreak  of  an  epidemic,  even  by  those 
who  have  made  a  particular  study  of  this  branch  of  medical  know 
ledge,  and  enjoyed  the  advantages  afforded  by  an  extensive  field  of 
observation  in  public  and  private  practice.  They  must,  necessarily, 
be  more  frequently  so  by  the  less  informed,  expert,  experienced,  or 
careful  members  of  the  profession,  or  by  those  who  do  not  enjoy 
the  opportunity,  or  whose  time  is  too  much  engrossed  to  prosecute 
the  study  of  pathological  anatomy  and  other  branches  of  medical 
knowledge,  without  which  it  is  in  vain  to  pretend  to  accuracy  in 
diagnosis.  Individuals  of  this  kind  necessarily  abound  in  every 
community,  though  nowhere  perhaps  more  than  in  this  country. 
Many,  hence,  may  be  very  apt  to  see  identity,  where  more  experi 
enced,  accurate,  and  trustworthy  diagnosticians  and  pathologists 
will  detect  diversity.  The  physicians  of  Charleston  find  no  diffi 
culty  in  distinguishing  the  yellow  or  stranger's  fever  from  the 
ordinary  endemic  remittent  of  the  adjacent  county,  which  by  some 
has  been,  without  due  attention  to  distinctive  phenomena  and  other 
important  circumstances,  confounded  with  the  former.  The  same 
may  be  said  of  other  diagnosticians  and  experienced  observers  in 
various  parts  of  this  country,  in  the  West  Indies,  on  the  coasts  of 
South  America  and  Africa,  and  in  Europe,  who  draw  the  line  of 
demarcation  between  those  fevers  with  undeniable  precision. 

The  best  French  and  English  pathologists,  as  well  as  many  accu 
rate  and  sound  observers  in  this  country,  have  learned  to  draw  a 
proper  distinction  between  typhus  and  typhoid  fevers,  and  so  on 
of  other  febrile  complaints  ;  and  they  would  probably  demur  to  the 
opinion  of  those  who  venture  to  maintain  that  typhus  and  typhoid 
fevers  are  identical  with  bilious,  remittent,  and  yellow  fevers.  In 
fact,  the  farther  knowledge  has  advanced — the  more  closely  the 
phenomena  of  the  diseases  mentioned  have  been  analyzed  and 
compared — the  more  their  mode  of  progression  has  been  scruti 
nized  and  their  anatomical  characters  minutely  and  accurately 
studied,  the  greater  has  been  the  tendency  among  medical  men  to 
draw  a  precise  line  of  distinction  between  their  several  forms.  So 
great,  indeed,  has  been  the  change  in  that  respect — such  the  in 
crease  in  the  number  of  its  advocates  in  quarters  where  minute 
and  correct  observations  are  alone  to  be  looked  for,  that  we  cannot 
err  greatly,  when  we  express  the  opinion  that  the  day  is  not  far 


AUTUMNAL    FEVERS.  493 

distant  when  physicians  generally,  regardless  of  the  clamour  of  a 
few  opponents,  will  feel  no  more  disposed  to  jumble  up  together 
the  different  varieties  of  fevers,  as  is  still  but  too  often  done  by  a 
certain  class  of  physicians,  than  they  do  now  to  regard,  as  did  our 
ancestors,  smallpox,  measles,  and  scarlet  fever  as  one  and  the  same 
disease,  really  and  substantially. 

That  difficulty  is  experienced  in  making  out  the  diagnosis  of 
fevers,  especially  in  the  commencement  of  an  attack,  no  doubt  can 
exist.  The  difficulty  is  often  felt,  even  by  experienced  physicians, 
in  the  case  of  diseases,  the  nature  and  causes  of  which  differ  essen 
tially,  and  which  approximate  only  in  being  attended  by  symptoms 
of  constitutional  excitement.  On  this  subject  I  need  hardly  insist. 
It  is,  or  certainly  ought  to  be,  admitted  by  all  who  have  the  least 
smattering  of  practical  medicine.  If  this  be  true  in  reference  to 
such  diseases,  the  embarrassment  may  well  be  admitted  to  occur 
much  more  frequently  when  the  complaints  to  be  diagnosed  are  of 
the  same  family,  though  of  different  species ;  for  all  know  that  in 
such  diseases  the  full  development  of  the  phenomena  which  serve  to 
characterize  the  case,  is  usually  preceded  by  febrile  symptoms  veiy 
similar  in  all ;  and  well  calculated,  on  that  account,  to  create  diffi 
culty  in  respect  to  the  diagnosis.  If  we  take,  for  example,  the 
incubative  symptoms  in  continued  fever,  we  shall  find  that  the 
description  of  them  may  apply  to  many  of  the  acute  blood  or 
zymotic  diseases. 

The  following  catalogue  of  symptoms  I  borrow,  like  Dr.  Simons, 
from  Dr.  Watson's  matchless  book  on  the  practice  of  medicine. 
"The  expression  of  the  patient's  countenance  alters;  he  becomes 
pale,  languid,  and  abstracted :  those  about  him  observe  that  he  is 
looking  very  ill.  lie  is  feeble,  and  easily  tired ;  reluctant  to  make 
any  exertion  of  mind  or  body  ;  listless,  and  often  apprehensive  of 
some  impending  evil ;  he  loses  his  appetite  ;  his  tongue  becomes 
white,  and  inclined  to  tremble;  the  bowels  are  irregular,  often  con 
fined,  sometimes  affected  with  diarrhoea;  his  senses  lose  their 
natural  delicac}^  lie  has  uneasiness  or  wandering  pains  in  various 
parts  of  the  body,  and  occasionally  there  is  some  giddiness ;  drow 
siness,  perhaps,  during  the  day,  and  unsound,  unrefreshing  sleep  at 
night.  In  a  word,  the  patient  droops.  The  regular  onset  of  the 
fever  is  very  frequently,  indeed,  marked  by  a  shivering  lit ;  another 
common  phenomenon  at  the  period  of  the  invasion  is  severe  head 
ache.  But  you  will  also  perceive,  even  when  there  have  been  no 


494  PNEUMONIA    AND 

premonitory  circumstances,  that  symptoms  arise,  even  thus  early, 
which  belong  to  the  nervous  system,  and  denote  some  disturbance 
and  alteration  in  the  functions  of  sensation,  thought,  and  voluntary 
motion.  They  are  comprised  under  the  general  phrase,  '  febrile 
oppression,'  and  they  are  different  from  what  we  notice  when 
pyrexia  or  feverishness  supervenes  upon  inflammation.  The  mus 
cular  power  is  sensibly  enfeebled.  Sometimes  the  patient  will 
struggle  against  this,  but  in  a  few  hours,  or  in  a  day  or  two  at  far 
thest,  he  takes  to  his  bed." 

To  these  symptoms,  which,  as  Dr.  Simons  remarks,  constitute 
equally  a  picture  of  most  of  the  diseases  of  the  class,  there  succeed 
a  stage  of  reaction  in  which  fever  runs  more  or  less  high.  The 
skin  is  hot  and  dry,  sometimes  moist ;  the  pulse  is  excited,  thirst  is 
developed,  and  so  on  of  other  symptoms  familiar  to  all  physicians ; 
and  it  is  only  after  these  have  continued  more  or  less  time  that  the 
characteristic  phenomena  manifest  themselves,  and  the  true  nature 
of  the  case  is  satisfactorily  made  out.  Exceptional  cases,  doubtless, 
are  found,  in  which  from  peculiar  signs,  aided  by  various  concomi 
tant  circumstances,  the  diagnosis  may  be  established  earlier.  But 
in  general  it  is  not  so;  and  every  prudent  physician  finds  it  better 
to  avoid  precipitancy  in  the  expression  of  his  opinion.  With  Dr. 
Nott,  therefore,  we  must  all  concur,  when  he  remarks :  "  If  a  phy 
sician  were  called  in  the  forming  stage  of  a  number  of  cases  of  the 
plague,  smallpox,  yellow  fever,  some  forms  of  typhus,  and  other 
diseases  arising  from  morbid  poisons,  as  well  as  certain  vegetable 
poisons,  he  would  be  much  at  a  loss  how  to  distinguish  them  for 
two  or  three  days  ;  and  in  some  of  those  in  which  the  characteristic 
signs  are  never  developed,  as  smallpox  without  eruption,  &c.,  a 
diagnosis  never  could  be  made.  It  should  not  be  wondered  at, 
then,  that  difficulty  of  diagnosis  should  sometimes  occur  between 
bilious  and  yellow  fever,  which  belong  to  the  same  family,  the  same 
season,  and  (often)  the  same  locality."1  Another  cause  of  difficulty 
in  the  diagnosis  depends  on  the  occurrence  of  the  complications 
already  adverted  to ;  for  it  is  a  circumstance  well  understood  by 
observant  and  experienced  pathologists,  and  which  has  not  escaped 
the  notice  of  some  of  our  distinguished  Southern  physicians,  that 
when  two  or  more  epidemic  or  atmospheric  diseases  prevail  to 
gether,  they  become  blended.  Under  circumstances  of  the  kind, 

1  N.  0.  J.  iv.  584. 


AUTUMNAL    FEVERS.  495 

yellow  fever,  especially  if  it  prevails  in  a  mild  form,  and  does  not, 
by  the  wide  diffusion  and  great  energy  of  the  poison  giving  rise  to 
it,  take  exclusive  possession  of  the  field,  becomes  more  or  less 
blended  with  remittents  and  intermittents  of  all  grades,  and  forms 
with  these  compounds,  which  may  sometimes  embarrass  the  most 
correct  diagnostician,  and  are  sure  to  puzzle  and  confuse  those  less 
expert  in  matters  of  the  sort,  and  to  lead  them  to  doubt  the  pro 
priety  of  establishing  a  line  of  demarcation  between  those  fevers. 

The  physician  who  would  be  astonished  at  the  appearance  of 
black  vomit,  in  a  case  of  what  he  fancies  to  be  ordinary  fever,  and 
who  would  always  wait  till  the  occurrence  of  that  formidable  symp 
tom  before  establishing  his  diagnosis  and  pronouncing  the  disease 
to  be  yellow  fever — who  could  not  know  the  latter  to  be  such  till 
the  patient  was  in  articulo  mortis — should  be  advised  (supposing  the 
case  to  have  been  really  of  the  kind  mentioned — for  every  one 
knows  that  black  vomit  alone  is  not  sufficient  to  characterize  yellow 
fever)  to  go  back  to  school,  or  to  keep  his  eyes  wider  open  the  next 
time.  If  the  appearance  of  black  vomit  were  indispensable  to  enable 
the  physician  to  establish  his  diagnosis,  it  would  follow  that,  in  a 
large  proportion  of  cases  of  what  there  can  be  no  doubt  is  yellow 
fever,  the  true  nature  of  the  disease  could  not  be  positively  ascer 
tained.  As  a  general  rule,  it  may  be  stated  that,  in  cases  that  reco 
ver,  black  vomit  does  not  make  its  appearance.  In  this  city,  the 
mortality  among  the  reported  cases  has  averaged  one  in  2.12,  the 
proportion  varying  from  one  in  1.2  to  one  in  3.86.  In  other  places, 
the  loss  has  occasionally  been  less.  The  number  of  those  who 
escape  that  symptom  must  hence  be  everywhere  larger  than  that 
of  those  who  suffer  from  it.  The  amount  of  the  former  will  be 
found  to  be  even  greater  than  here  stated;  for  those  who  die  do  not 
all  eject  the  fluid,  and  it  then  requires  an  autopsy  to  ascertain  that 
it  has  been  effused.  And  yet  no  difficulty  is  experienced,  in  those 
who  recover,  or  die  without  throwing  up  the  black  matter,  in  dis 
tinguishing  the  disease  from  other  forms  of  febrile  complaints. 
Such  errors  are  generally  the  result  of  want  of  skill  or  want  of  at 
tention  on  the  part  of  the  observer ;  for  the  yellow  fever,  as  also 
the  remittent,  present,  together  with  phenomena  approximating 
them  to  each  other  and  to  different  complaints,  characteristic  fea 
tures  of  their  own,  which,  when  duly  and  carefully  examined  and 
analyzed,  prevent  the  one  from  being  mistaken  for  the  other, 
except  in  cases  of  an  anomalous  or  complicated  nature,  or  at  the 


496  PNEUMONIA    AXD 

very  outset  of  the  attack — of  mild  cases  especially — or  which,  at 
any  rate,  enable  the  physician  to  establish  his  diagnosis,  in  the  ordi 
nary  forms  of  the  disease,  long  before  the  accession  of  that  formida 
ble  symptom.  The  blunders  of  the  unskilful  or  careless,  or  the 
fancies  of  the  Unitarian  must  not  be  urged  in  denial  of  the  possi 
bility  of  tracing  a  line  of  distinction  between  the  different  forms  of 
autumnal  fevers.  Let  them,  by  way  of  encouragement,  peruse  the 
following  statement  made  by  a  clever  physician  of  Mobile :  Two 
clergymen  of  this  city,  Mr.  Balzan  and  Mr.  Dorman,  whose  active 
benevolence  has  won  for  them  much  correct  information  in  relation 
to  fevers,  have  frequently,  in  my  private  and  hospital  practice,  de 
signated  each  variety  and  grade  of  fever  with  the  greatest  ease  and 
correctness,  separating  the  grave  from  the  ephemeral  cases  of  yellow 
fever,  and  distinguishing  these  again  from  periodic  fever.  In  their 
diagnosis  they  were  governed  by  the  character  of  fever,  pain,  rest 
lessness,  colour  of  skin,  physiognomy,  paroxysms,  and  nature  of  the 
secretions.1 

I  have  not  ^infrequently  heard  it  affirmed  by  physicians  of  the 
South,  who  favour  the  opinion  under  examination,  that  the  identity 
contended  for  is  shown  by  the  fact  that  men  digging  down  a  bluff 
will  often  become  sickly,  and  have  fever  with  periodicity.  Physi 
cians  who  attend  them  report  some  to  be  affected  with  hepatitis 
with  complication  of  pneumonia,  and  the  reverse ;  others  to  have 
gastritis  complicated  with  phrenitis,  and  the  reverse;  enteritis,  ne 
phritis,  &c.,  with  their  complications;  remittent  bilious  fever,  inter 
mittent  fever,  yellow  fever,  &c.  &c.  Now,  it  is  argued,  all  these  men 
derive  their  sickliness  from  the  same  cause — the  digging  down 
of  a  bluff,  &c.  If  one  and  the  same  cause  can  produce  so  many 
groups  of  morbid  phenomena,  docs  it  not  seem  almost  certain  that 
the  disease  thus  engendered,  though  designated  by  as  many  as  forty 
different  names,  is  essentially  the  same  in  all  cases  ? 

For  my  part  I  must,  with  due  deference,  demur  to  this  conclu 
sion,  and  express  the  belief  that  I  shall  be  fully  sustained  by  many 
well-informed  and  experienced  physicians  on  this  and  the  other  side 
of  the  Atlantic,  Avhen  I  deny  the  possibility  of  so  great  a  variety 
and  diversity  of  well-marked  effects  resulting  from  the  agency  of 
one  and  the  same  cause;  or  of  the  same  disease  assuming  such  a 
diversity  of  forms  as  to  simulate  as  many  as  forty  separate  diseases, 

1  Lewis,  Fever  of  Mobile  in  1847,  N.  0.  J.  v.  40. 


AUTUMXAL    FEVEKS.  -i97 

each  entitled  to  a  separate  name,  and  occupying  a  separate  place  in 
our  nosological  arrangements.  If  it  be  found  that .  a  number  of 
men,  employed  in  cutting  clown  a  bluff,  are  seized  with  a  diversity 
of  what  we  are  accustomed  to  regard  as  distinct  diseases,  and  that 
these  are  all  referred  to  the  same  cause;  or  if  we  are  told  that  the 
disease  in  all  these  cases  is  the  same,  but  has  assumed  a  diversity 
of  aspects,  and  merely  presented  itself  in  a  variety  of  groups  of 
symptoms,  which,  though  having  in  many  instances  little  or  no 
resemblance  to  each  other,  are  nevertheless  the  offspring  of  one 
and  the  same  parent,  pathologists  will,  in  all  probability,  be  dis 
posed  to  accuse  the  reporters  with,  betraying  a  great  deficiency  of 
knowledge,  both  as  regards  the  nature  and  causation  of  the  morbid 
phenomena  described ;  or  with  an  unpardonable  degree  of  hastiness 
and  carelessness  in  the  manner  of  making  their  observations  and 
drawing  their  conclusions;  or  perhaps  with  being  under  the  spell 
of  some  preconceived  notion  or  favourite  hobb}^.  The  digging 
of  no  ditch  or  can^  the  cutting  down  of  no  bluff,  the  levelling 
of  no  streets,  has  ever  produced, such  diversified  complaints;  and 
when  we  hear  of  physicians  giving  many  names — no  matter  whe 
ther  ten  or  forty — to  the  morbid  phenomena  resulting  from  the 
agency  of  exhalations  issuing  from  the  upturned  earth,  we  may 
safely  set  them  down  as  erring;  and  as  having,  owing  to  their  in 
ability  to  establish  a  correct  diagnosis,  regarded  in  the  light  of  dis 
tinct  diseases  what  other  and  more  careful  observers  would  have 
found  to  be  otherwise.  On  the  other  hand,  when  several  diseases 
are  really  found  to  occur  among  men  thus  similarly  employed — a 
circumstance  not  unlikely  to  occur — it  is  much  more  natural  to 
conclude  that  different  causes  have  been  simultaneously  at  work, 
and  that  each  has  produced  its  legitimate  effects,  than  to  attribute 
those  diseases  to  the  same  agent,  which,  from  our  experience  else 
where,  and  under  different  circumstances,  we  have  reason  to  think 
are  incapable  of  giving  rise  to  such  multitudinous  and  diversified 
phenomena.  Such  diggings  and  cuttings  produce  no  catarrh,  no 
pleurisy,  no  pneumonia,  &c. ;  and  if  .those  diseases  occur  among  the 
diggers  and  cutters,  there  is  no  reason  why  they  should  not  be 
occasioned  by  the  causes  that  produce  them  elsewhere ;  as  well 
where  fevers  prevail,  as  where  they  are  not  observed ;  as  well  where 
the  fresh,  earth  has  been  recently  exposed,  as  where  it  has  not  been 
disturbed.  From  such  operations,  when  undertaken  in  particular 
seasons  of  the  year,  in  certain  localities,  and  within  certain  degrees 
32 


498  PNEUMONIA    AND 

of  terrestrial  altitude,  diseases,  sometimes  of  a  formidable  character^ 
undoubtedly  result.  This  was  exemplified  in  New  Orleans  at  the 
time  of  the  opening  of  the  Carondelet  Canal,  in  1794-1797;  in  the 
same  city,  during  the  extensive  paving  executed  in  1817,  1824, 
1832 ;  and  at  the  opening  of  the  Bank  Canal,  in  1832-1835.  It  was 
also  exemplified  in  Natchez,  at  the  period  of  the  levelling  of  the 
streets,  in  1816, 1825;  at  Memphis,  Tenn.,  within  the  last  few  years; 
and,  indeed,  as  already  seen,  in  every  place  where  canals,  ditches, 
and  other  excavations  have  been  made,  and  the  earth  extensively 
upturned.  But  in  all  such  instances  the  disease  produced  has  been 
fever;  often  of  a  malignant,  at  other  times  of  a  remittent  form; 
according  to  the  season  of  the  year,  the  peculiarities  of  the  weather, 
the  nature  of  the  soil,  and  other  influencing  circumstances,  which 
it  is  needless  to  enumerate. 

I  am  not  ignorant  of  the  fact  that,  by  many  physicians  who  en 
tertain  sentiments  different  from  those  expressed  in  the  preceding 
pages,  little  or  no  respect  is  paid  to  the  opinions  of  professional 
writers  or  teachers,  however  eminent  these  may  be.  Few  of  my 
readers  can  have  failed  to  hear  such  authorities  unceremoniously 
stigmatized,  by  those  who  throw  out  some  new  or  revive  some 
antiquated  and  forgotten  notion,  as  being  a  long  way  behind  the 
times,  and  as  having  not  yet  renounced  the  Aristotelian,  and  fully 
adopted  the  Baconian  philosophy.  It  is  not  uncommon,  to  hear  it 
affirmed  that  the  whole  system  of  pathology  and  practice,  etiology 
and  physiology  of  fever  and  febrile  affections,  is  founded  upon  pre 
conceived  notions,  and  not  upon  facts  and  inductions,  and  that  it 
requires  to  be  remodelled  on  more  correct  principles.  All  this, 
and  much  more  of  similar  import,  we  are  not  unfrequently  told  in 
ephemeral  publications,  and  even  in  works  of  higher  pretensions. 
I  have  neither  room  nor  inclination  to  examine  here  how  far  such 
assertions  are  warranted,  and  to  enlarge  on  the  degree  of  improve 
ment  to  which  medical  inquirers  and  teachers  among  them  have 
attained  in  the  several  departments  of  medical  knowledge,  or  to 
inquire  Avherc  the  desired  revolution  in  professional  opinion  con 
cerning  those  important  subjects  is  more  likely  to  originate.  It 
will  be  sufficient  to  remark  that,  in  regard  to  the  matter  more  par 
ticularly  before  us,  professional  investigators — the  enlightened  por 
tion  of  them,  I  mean — so  far  from  being  sadly  behind  the  times, 
are,  as  every  unprejudiced  reader  must  know,  far  ahead  of  their 
predecessors ;  and  that  nothing  has  been  said  or  done  bv  contem- 


AUTU.MXAL    FEVERS.  499 

porary  writers,  in  this  country  or  elsewhere,  to  disprove  the  cor 
rectness  of  their  conclusions.  It  is,  indeed,  precisely  in  reference 
to  the  very  subjects  specified,  that  the  science  seems  to  me  to  have 
mostly  improved.  An  examination  of  professional  records  will 
show  that,  in  every  place  where  the  opportunity  of  carrying  on 
the  investigation  on  a  sufficiently  enlarged  scale,  and  with  proper 
minutiae  and  thoroughness,  has  presented  itself,  and  where  men 
possessing  the  talents  and  knowledge  requisite  to  study  and  extend 
the  stock  of  information,  and  to  lay  the  result  of  their  inquiries 
effectively  before  the  public,  have  set  to  work,  the  pathology, 
etiology,  and  therapeutics  of  fevers  and  febrile  diseases  (including 
parenchymatous  and  membranous  inflammations)  have  been  dili 
gently  and  successfully  studied,  and  our  knowledge  respecting 
them  has  been  very  greatly  enlarged. 

The  knowledge  thus  accumulated  has  been  very  freely  laid  before 
the  medical  public,  and  through  means  of  the  writings  of  those 
pioneers  in  the  cause  of  science  and  of  their  followers,  every  read 
ing  physician  or  teacher  has  the  opportunity,  if  he  thinks  fit  to 
embrace  it,  of  becoming  fully  informed  as  to  the  matter  in  question. 
If  many,  therefore,  among  us  and  elsewhere,  are  found  to  be 
truly  amenable  to  the  charge  of  being  sadly  behind  the  times,  the 
fault  necessarily  lies  with  them  and  no  one  else.  They  constitute, 
at  best,  only  a  portion — I  hope  a  minority — of  our  professional 
brethren.  Hence,  there  can  scarcely  be  any  more  truth  or  justice 
in  the  assertion  that  medical  men,  and  professional  teachers  gene 
rally,  must  find  a  place  in  this  category  of  ignoramuses;  that  they 
have  all  lagged  a  good  way  behind  the  times;  that,  therefore,  their 
opinions  should  be  discarded  on  the  score  of  their  being  antiquated, 
and  no  longer  on  a  level  with  the  state  of  knowledge  on  the  sub 
ject,  than  there  would  be  foundation  for  the  idea  that  the  medical 
inquirer  must  turn,  for  truly  correct  notions  regarding  the  patho 
logy,  causation,  or  treatment  of  fevers,  to  the  lucubrations  of  the 
above  few.  The  assertion,  I  say,  is  not  founded  in  justice,  nor  on 
solid  ground;  for  the  opinions  thus  impeached  are  the  result  of  a 
considerable  amount  of  correctly  observed  facts,  and  are  based  on 
philosophical  deductions  of  the  strictest  kind;  and  should,  as  such,  be 
respected  till  disproved  by  others  founded  on  equally  well  observed 
and  equally  numerous  data.  It  is  certain,  indeed,  that,  so  far  from 
the  whole  system  of  pathology,  &c.  of  fevers  and  febrile  diseases 
being  founded  on  preconceived  notions,  and  not  upon  facts  and 


000  PNEUMONIA    AND 

inductions,  a  careful  survey  of  what  has  been  done  on  the  subject 
in  France,  England,  Germany,  and  the  large  cities  of  this  country, 
will  show  that  the  views  at  present  entertained  are  based  upon 
nothing  but  facts  and  legitimate  deductions,  to  the  exclusion  of  pre 
conceived  notions;  that  there  never  was  a  period  when  the  en 
lightened  portion  of  medical  men  were  less  disposed  to  be  biased 
by  such  notions,  and  when  they  have  less  allowed  themselves  to  be 
led  astray  by  fanciful  speculation  in  their  conclusions  on  pathological 
and  etiological  questions  than  at  present;  and  that,  in  fact,  such  a 
cutting  loose  from  the  shackles  of  preconceived  notions  constitutes 
the  distinctive  characteristic  of  the  present  mode  of  investigation  as 
regards  the  nature,  the  cause,  the  mode  of  progression,  and  the  treat 
ment  of  fevers  and  febrile  diseases,  and,  indeed,  of  every  other  morbid 
ailment.  The  doctrine  of  Broussais,  erroneous  as  it  may  appear  to 
many  at  the  present  day,  was  based  on  important  facts,  often  well 
explained,  and  leading  to  correct  or  plausible  deductions.  The  at 
tentive  readers  of  his  Pldegmasies  Chromques,  of  his  first  Examen,  and 
of  his  Commentaries,  will  not  gainsay  me  in  this.  The  doctrine  was 
faulty,  not  in  the  deficiency  of  the  facts  upon  which  it  was  based,  but 
in  the  nature  of  many  conclusions  drawn  from  them.  But  how  was 
it  overthrown  ?  Certainly,  not  through  the  operation  of  a  greater 
power  of  reasoning  possessed  by  Broussais's  antagonists,  for  some  of 
the  most  successful  among  them  are  not  particularly  gifted  on 
that  score,  but  by  facts  more  numerous,  more  carefully  observed 
and  analyzed,  and  more  accurately  compared  with  each  other. 
How  have  we  acquired  our  present  knowledge  of  the  pathology  of 
typhoid  fever  ?  Open  the  works  of  Louis,  Andral,  Chomel,  Jenner, 
Gerhard,  Flint,  and  see  whether  facts  are  wanting.  How  have 
physicians  attained  their  present  views  of  the  pathologv  and  ana 
tomical  characters  of  pulmonary  or  cardiac  diseases?  How  have  they 
learned  to  ascertain,  by  means  of  auscultation  and  percussion,  the 
condition  of  internal  organs?  Is  it  by  abstract  reasoning,  or  by 
following  out  and  cherishing  some  exclusive  and  dominant  idea,  and 
forcing  everything  to  bend  to  it;  some  preconceived  notions;  or 
is  it  not  rather  through  the  instrumentality  of  facts  accumulated 
in  France,  England,  Germany,  and  a  small  portion  of  this  country? 
It  can  scarcely  be  necessary  to  answer  the  question. 

Those  who  raise  such  an  outcry  about  the  necessity  of  facts,  and 
reprove  the  most  authoritative  writers  and  teachers  for  a  supposed 
adherence  to  preconceived  notions,  and  a  neglect  of  the  true  prin- 


AUTUMNAL    FEVERS.  501 

ciplcs  of  the  inductive  philosophy,  should  first  satisfy  the  profession, 
not  only  that  they  are  less  liable  to  error  than  their  opponents,  in 
drawing  deductions  from  the  facts  they  may  happen  to  collect,  but 
that  these  facts  have  been  examined  in  a  way  calculated  to  insure 
advantageous  results.  They  should  remember  that,  great  as  the 
number  of  useless  theories  may  be,  it  sinks  into  insignificance 
when  compared  with  the  amount  of  incomplete  facts  which  float 
around  us.  To  observe  accurately — to  seize  the  important  and 
useful  points  in  the  case  examined — to  discover  its  true  bearing 
to  other  cases,  its  exact  analogy  to  or  dissimilarity  from  them — 
to  ascertain  its  dependence  on,  or  independence  of,  surrounding 
influences — to  point  out  accurately  the  morbid  agencies  which  have 
produced  it,  and  to  ascend  by  an  analysis  of  its  symptoms  and 
anatomical  characters,  to  its  pathological  nature  and  therapeu 
tical  indications,  require  a  degree  of  skill,  a  tact,  a  habit  of  close 
observation  that  are  not  easily  acquired,  as  well  as  opportunities  for 
investigation  that  do  not  fall  to  the  lot  of  every  one.  And  yet  a 
writer  must  give  proof  of  possessing  them  before  he  can  expect  to 
command  the  attention  of  the  cautious  inquirer,  and  change  the 
current  of  professional  belief.  "  A  vast  mass  of  facts,"  says  a  recent 
writer,  "may  be  collected  and  tabulated — the  numerical  method 
may  be  applied  in  every  conceivable  mode — and  yet,  so  long  as  no 
connecting  idea  is  discovered  among  them,  they  remain  utterly 
incapable  of  serving  for  the  establishment  of  those  general  prin 
ciples  which  enable  true  science  to  predict  with  certainty  what  will 
not  occur  in  any  given  contingency;  and  which,  therefore,  furnish 
the  only  satisfactory  basis  for  the  use  of  art  as  to  what  should  or 
should  not  be  done."  A  great  master,  Montesquieu,  has  said:  "Un 
fait  qui  n'emporte  pas  une  idee,  duquel  on  ne  pent  pas  s'elever 
pour  voire  plus  loin,  est  un  caillou  qui  ne  vaut  pas  la  peine  d'etre 
ramasse,  et  qu  'il  faut  au  contraire  repousser  du  pied  pour  en  de- 
barasser  la  route." 

What  the  result  of  the  mode  of  proceeding  adopted  at  this  day 
by  standard  pathologists  has  been  as  regards  the  distinctive  pathog- 
nomonic  marks,  and  the  separate  nosological  positions  of  the 
several  forms  of  fevers,  properly  so  called,  has  already  been  stated. 
Much  the  same  may  be  found  in  reference  to  other  febrile  com 
plaints  dependent  on  local  inflammation,  as  well  as  to  other  dis 
eases  ;  to  the  symptoms  and  anatomical  characters  by  which  they 
are  recognized,  and  which  distinguish  them  from  each  other  and 


502  PNEUMONIA    AND   AUTUMNAL    FEVERS. 

from  the  pyrexiae,  as  well  as  to  the  causes  by  which  they  are  pro 
duced.  Now  if  in  the  course  of  this  revolutionizing  movement, 
and  at  the  present  period  of  progressive  improvement,  some  medical 
writers  or  teachers  are  really  found  to  be  a  long  way  behind  the 
times,  it  can  scarcely  be  those  who  have  taken  an  active  part  in  the 
race  of  investigation,  who  have  helped  to  overthrow  old  and 
erroneous  views,  and,  by  appealing  to  facts,  to  place  matters  in  a 
proper  light,  or  who  have  diligently  and  carefully  studied  the  works 
of  modern  standard  writers.  They  must  be  sought  elsewhere. 

Here  I  must  close  the  remarks  I  wished  to  offer  in  opposition  to 
the  supposed  connection  between  pneumonia  and  periodic  fevers. 
They  have  extended  far  beyond  what  was  originally  intended.  For 
this  the  reader  is  entitled  to  many  apologies.  The  greater  part  of 
the  volume  thus  inflicted  on  him  was  penned  somewhat  in  haste, 
and  under  the  pressure  of  a  variety  of  circumstances  unfavourable 
to  minute  investigation,  systematic  arrangement,  and  correct  com 
position.  With  more  tranquillity  around  me,  with  a  larger  share 
of  health  than  I  have  recently  enjoyed,  with  a  freer  and  more  con 
stant  access  to  publications  relating  to  the  questions  at  issue,  and 
especially  with  more  leisure  at  my  command,  it  might  have  been 
presented  in  a  shape  more  acceptable  to  those  who  will  do  me  the 
honour  to  peruse  it.  But  I  must  plead  as  an  excuse,  the  same  reason 
which  Voltaire  assigned  for  having  written  a  very  long  letter  to 
one  of  his  princely  correspondents — I  had  not  time  sufficient  to 
write  more  briefly.  Such  as  it  is,  with  all  its  many  imperfections 
and  gross  defects  of  commission  and  omission,  these  remarks  are 
placed  before  the  medical  public  in  the  hope  that  they  may  do  some 
service,  and  contribute  in  some  measure  to  the  settlement  of  the 
question ;  or  at  any  rate  that  they  may  excite  in  others,  better 
qualified  for  the  task,  a  desire  to  point  out,  in  an  ampler,  clearer, 
more  logical,  and  more  forcible  manner,  the  groundless  nature  and 
dangerous  tendencies  of  the  pathological  and  etiological  heresies  to 
which  I  have  called  attention. 


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MALGAIGNE'S  OPERATIVE  SURGERY,  with  wood-cuts. 
SIMON'S  LECTURES  ON  GENERAL  PATHOLOGY. 
BENNETT  ON  PULMONARY  TUBERCULOSIS,  with  wood-cuts,  and 
WEST  ON  ULCERATION  OF  THE  OS  UTERI. 

While  the  year  1855,  presents 
BROWN    ON    THE   SURGICAL    DISEASES    OF    FEMALES. 

HANDSOMELY    ILLUSTRATED    ON    WOOD. 

The  diseases  treated  in  this  volume  have  hitherto  not  received  from  writers  of  systematic 
works  the  attention  to  which  their  importance  entitles  them.  In  treatises  on  female  diseases  they 
have  been  but  little  noticed,  as  belonging  more  properly  to  the  surgeon,  while  our  surgical  text-books 
have  in  like  manner  referred  them  to  the  writer  on  midwifery  and  female  affections.  In  supplying 
this  palpable  vacancy  in  medical  literature,  Mr.  Brown  has  brought  to  his  subject  the  result  of 
many  years  of  observation  and  experience,  and  his  labors  will  prove  of  much  value  to  all  practi 
tioners.  The  publishers  therefore  flatter  themselves  that  in  securing  this  volume  for  the  "  LIBRARY 
DEPARTMENT"  of  the  "  MEDICAL  NEWS"  they  will  meet  the  wishes  of  their  numerous  subscri 
bers,  who  will  thus  receive  this  highly  important  work  free  of  all  expense. 

It  will  thus  be  seen  that  for  the  small  sum  of  FIVE  DOLLARS,  paid  in  advance,  the  subscriber 
will  obtain  a  Quarterly  and  a  Monthly  periodical, 

EMBRACING  ABOUT  FIFTEEN  HUNDRED  LARGE  OCTAVO  PAGES, 

mailed  to  any  part  of  the  United  States,  free  of  postage. 

These  very  favorable  terms  are  now  presented  by  the  publishers  with  the  view  of  removing  all 
difficulties  and  objections  to  a  full  and  extended  circulation  of  the  Medical  Journal  to  the  office  of 
every  member  of  the  profession  throughout  the  United  Slates.  The  rapid  extension  of  mail  facili 
ties,  will  now  place  the  numbers  before  subscribers  with  a  certainty  and  dispatch  not  heretofore 
attainable;  while  by  the  system  now  proposed,  every  subscriber  throughout  the  Union  is  placed 
upon  an  equal  footing,  at  the  very  reasonable  price  of  Five  Dollars  for  two  periodicals,  without 
further  expense. 

Those  subscribers  who  do  not  pay  in  advance  will  bear  in  mind  that  their  subscription  of  Five 
Dollars  will  entitle  them  to  the  Journal  only,  without  the  News,  and  that  they  will  be  at  the  expense 
of  their  own  postage  on  the  receipt  of  each  number.  The  advantage  of  a  remittance  when  order 
ing  the  Journal  will  thus  be  apparent. 

As  the  Medical  News  and  Library  is  in  no  case  sent  without  advance  payment,  its  subscribers 
will  alwnys  receive  it  free  of  postage. 

It  should  also  be  borne  in  mind  that  the  publishers  will  now  take  the  risk  of  remittances  by  mail, 
only  requiring,  in  cases  of  loss,  a  certificate  from  the  subscriber's  Postmaster,  that  the  money  was 
duly  mailed  and  forwarded. 

Address,  BLANCHARD  &  LEA,  PHILADELPHIA. 


AND    SCIENTIFIC    PUBLICATIONS. 


ANALYTICAL    COMPENDIUM 
OF  MEDICAL  SCIENCE,  containing  Anatomy,  Physiology,  Surgery,  Midwifery, 

Chemistry,  Materia  Medica,  Therapeutics,  and  Practice  of  Medicine.  By  JOHN  NEILL,  M.  D., 
and  F.  G.  SMITH,  M.  D.  Second  and  enlarged  edition,  one  thick  volume  royal  12mo.  of  over 
1000  pages,  with  350  illustrations.  E2T  See  NEILL. 


ABEL   (F.    A.),    F.  C.  S. 

Professor  of  Chemistry  in  the  Royal  Military  Academy,  Woolwich. 

AND 

C.    L.    BLOXAM, 

Formerly  First  Assistant  at  the  Royal  College  of  Chemistry. 

HANDBOOK  OF  CHEMISTRY,  Theoretical,  Practical,  and  Technical,  with  a 
Recommendatory  Preface  by  Dr.  HOFMANN.  In  one  large  octavo  volume  of  602  pages,  with 
illustrations.  (Now 


The  present  volume  is  a  synopsis  of  their  (the    lent  guide,  since  he  will  find  in  it,  not  merely  the 


authors')  experience  in  laboratory  teaching  ;  it  gives 
the  necessary  instruction  in  chemical  manipulation, 


approved  modes  of  analytical  investigation,  but  most 
descriptions  of  the  apparatus  necessary-  with  such 


a  concise  account  of  general  chemistry  as  far  as  it  is  '  manipulatory  details  as  rendered  Faraday's  '  Che- 
involved  in  the  operations  of  the  laboratory,  and  last-  mical  Manipulations'  so  valuable  at  the  time  of  its 
ly,  qualitative  and  quantitative  analysis.  Itmustbe  publication.  Beyond  this,  the  importance  of  the 
understood  that  this  is  a  work  fitted  for  the  earnest  work  is  increased  by  the  introduction  of  much  of 
student,  who  resolves  to  pursue  for  himself  a  steady 
search  into  the  chemical  mysteries  of  creation.  Fo'r 
such  a  student  the  '  Handbook'  will  prove  an  excel- 


the  technical  chemistry  of  the  manufactory." — Dr 
Hofmann's  Preface. 


ASHVVELL    (SAMUEL), 

Obstetric  Physician  and  Lecturer  to  Guy's  Hospital,  London. 

A  PRACTICAL  TREATISE  ON  THE  DISEASES  PECULIAR  TO  WOMEN. 

Illustrated  by  Cases  derived  from  Hospital  and  Private  Practice.  Third  American,  from  the  Third 
and  revised  London  edition.     In  one  octavo  volume,  of  over  500  pages.    (Now  Ready.) 
The  most  able,  and  certainly  the  most  standard  |  practical  skijl,  and  sound  sense.— British  and  Fo- 
and  practical,  work  on  female  diseases  that  we  have 


yet  seen. — Medico-Chirurgical  Review. 

We  commend  it  to  our  readers  as  the  best  practi- 
tical  treatise  on  the  subject  which  has  yet  appeared 
— London  Lancet. 

The  young  practitioner  will  find  it  invaluable, 
while  those  who  have  had  most  experience  will  yet 
find  something  to  learn,  and  much  to  commend,  in  a 
book  which  shows  so  much  patient  observation, 


reign  Med.  Revieio. 

With  no  work  are  we  acquainted,  in  which  the 
pleasant  and  the  useful  are  more  happily  blended.  It 
combines  the  greatest  elegance  of  style  with  the 
most  sound  and  valuable  practical  information. 
We  feel  justified  in  recommending  it,  in  unqualified 
terms,  to  our  readers,  as  a  book  from  which  they 
can  scarcely  fail  to  derive  both  pleasure  and  im 
provement.  It  is  truly  a  model  for  medical  compo 
sitions. — Southern  Med.  and  Surg.  Journal. 


ARNOTT    (NEILL),  M.  D. 

ELEMENTS  OF  PHYSICS;  or  Natural  Philosophy,  General  and  Medical. 
Written  for  universal  use,  in  plain  or  non-technical  language.  A  new  edition,  by  ISAAC  HAYS. 
M.  D.  Complete  in  one  octavo  volume,  of  484  pages,  with  about  two  hundred  illustrations. 

BENNETT    (HENRY),  M.  D. 
A  PRACTICAL   TREATISE    ON   INFLAMMATION  OF   THE  UTERUS 

ITS  CERVIX  AND   APPENDAGES,  and  on  its  connection  with  Uterine  Disease.     Fourth 

American,  from  the  third  and  revised  London  edition.     In  one  neat  octavo  volume,  of  430  pages. 

with  wood-cuts.      Just  Issued.) 

This  edition  will  be  found  materially  improved  over  its  predecessors,  the  author  having  carefully 
revised  it,  and  made  considerable  additions,  amounting  to  about  seventy-h've  pages. 

This  edition  has  been  carefully  revised  and  altered,  ,  When,  a  few  years  back,  the  first  edition  of  the 
and  various  additions  have  been  made,  which  render  |  present  \york  was  published,  the  subject  was  oneal- 
it  more  complete,  and,  if  possible,  more  worthy  of  ]  most  entirely  unknown  to  the  obstetrical  celebrities 
the  high  appreciation  in  which  it  is  held  by  the  ;  of  the  day  ;  and  even  now  \ve  have  reason  to  know 
medical  profession  throughout  the  world.  A  copy  j  that  the  bulk  of  the  profession  are  not  fully  alive  to 
should  be  in  the  possession  of  every  physician. —  the  importance  and  frequency  of  the  disease  of  which 
Charleston  Med.  Journal  and  Review.  it  takes  cognizance.  The  present  edition  is  so  much 

We  are  firmly  of  opinion  that  in  proportion  as  a  '.  enlarged,  altered,  and  improved,  that  it  can  scarcely 
knowledge  of  uterine  diseases  becomes  more  appre-  \  be  considered  the  same  work.— Dr.  Ranking's  Ab- 
ciated,  this  work  will  be  proportionably  established  ,  stract. 
as  a  text-book  in  the  profession.— The  Lancet. 

BROWN    (ISAAC    BAKER)., 

Surgeon- Accoucheur  to  St.  Mary's  Hospital,  &c. 

ON  SOME  DISEASES  OF  WOMEN  ADMITTING  OF  SURGICAL  TREAT 
MENT.  With  handsome  illustrations.  One  vol.  8vo.  (At  Press.) 

Publishing  in  the  "Medical  News  and  Library"  for  1855.     See  preceding  pa^e. 
Mr.  Brown  has  earned  for  himself  a  high  reputa-  :  and  merit  the  careful  attention   of  every   surgeon- 
tion  in  the  operative  treatment  of  sundry  diseases  '  accoucheur. — Association  Journal 
and  injuries  to  which  females  are  peculiarly  subject   j      We  have  m)  hegitation  jn  re(;Ommendin-  this  book 
We  can  truly  say  01  his  work  that  it  is  an  important    to  the  careful  attention  of  all   sur,eons  who  make 
addition  to  obstetrical  literature      The  operative    female  complaints  a  part  of  their /K  and  practfc" 
suggestions  and  contrivances  which  Mr.  Brown  de-    _Dublin  (juarterly  JOWrna 
scribes,  exhibit  much  practical  sagacity  and  skill,  | 


BLANCHARD    &    LEA'S   MEDICAL 


BENNETT    (J.    HUGHES),    M.D.,    F.  R.  S.  E., 

Professor  of  Clinical  Medicine  in  the  University  of  Edinburgh,  &c. 

THE  PATHOLOGY  AND  TREATMENT  OF  PULMONARY  TUBBRCU- 

LOSIS,  and  on  the  Local  Medication  of  Pharyngeal  and  Laryngeal  Diseases  frequently  mistaken 
lor  or  associated  with.  Phthisis.     Jn  one  handsome  octavo  volume,  with  beautiful  wood-cuts. 

(Noiv  Ready.} 


BILLING    (ARCHIBALD),  M.  D. 
THE  PRINCIPLES  OF  MEDICINE.     Second  American,  from  the  Fifth  and 

Improved  London  edition.     In  one  handsome  octavo  volume,  extra  cloth,  250  pages. 


BLAKISTON    (PEYTON),  M.  D.,  F.  R.  S.,  &c. 
PRACTICAL    OBSERVATIONS    ON    CERTAIN    DISEASES     OF    THE 

CHEST,  and  on  the  Principles  of  Auscultation.     In  one  volume.  8vo.,  pp.  384. 


BURROWS    (GEORGE),   M.D. 

ON  DISORDERS  OF  THE  CEREBRAL  CIRCULATION,  and  on  the  Con 
nection  between  the  Affections  of  the  Brain  and  Diseases  of  the  Heart.  In  one  8vo.  vol.,  with 
colored  plates,  pp.  21b'. 

BUDD  (GEORGE),  M.  D.,  F.  R.  S., 

Professor  of  Medicine  in  King's  College,  London. 

ON   DISEASES   OF   THE   LIVER.     Second  American,  from  the  second  and 

enlarged  London  edition.     In  one  very  handsome  octavo  volume,  with  four  beautifully  colored 
plates,  and  numerous  wood-cuts,     pp."  468.    New  edition.     (Just  Issued.) 

The  reputation  which  this  work  has  obtained  as  a  full  and  practical  treatise  on  an  important  class 
of  diseases  will  not  be  diminished  by  this  improved  and  enlarged  edition.  It  has  been  carefully  and 
thoroughly  revised  by  the  author ;  the  number  of  plates  has  been  increased,  and  the  style  of  its  me 
chanical  execution  will  be  found  materially  improved. 


The  full  digest  we  have  given  of  the  new  matter 
introduced  into  the  present  volume,  is  evidence  of 
the  value  we  place  on  it.  The  fact  that  the  profes 
sion  has  required  a  second  edition  of  a  monograph 
such  as  that  before  us,  bears  honorable  testimony 
to  its  usefulness.  For  many  years,  Dr.  Budd's 


work  must  be  the  authority  of  the  great  mass  of 
British  practitioners  on  the  hepatic  diseases  ;  and  it 
is  satisfactory  that  the  subject  has  been  taken  up  by 
so  able  and  experienced  a  physician. — British  and 
Foreign  Medico-Chirurgical  Jieview. 


BUSHNAN   (J.   S.),    M.  D. 
THE   PHYSIOLOGY  OF   ANIMAL  AND  VEGETABLE   LIFE;  a  Popular 

Treatise  on  the  Functions  nnd  Phenomena  of  Organic  Life.  To  which  is  prefixed  a  Brief  Expo 
sition  of  the  great  departments  of  Human  Knowledge.  In  one  handsome  royal  12mo.  volume, 
with  over  one  hundred  illustrations. 

Though  cast  in  a  popular  form  and  manner,  this  work  is  the  production  of  a  man  of  science,  and 
presents  its  subject  in  its  latest  development,  based  on  truly  scientific  and  accurate  principles. 
It  may  therefore  be  consulted  with  interest  by  those  who  wish  to  oUlain  in  a  concise  form,  and  at 
a  very  low  price,  a  resume  of  the  present  staie  of  animal  and  vegetable  physiology. 


BLOOD  AND   URINE  (MANUALS  ON). 
BY  JOHN   WILLIAM   GRIFFITH,   G.  OWEN  REESE,   AND   ALFRED 

MARKWICK.     One  thick  volume,  royal  12mo.,  extra  cloth,  with  plates,     pp.  460. 


BRODIE  (SIR  BENJAMIN   C.),  M.  D.,  &c. 
CLINICAL  LECTURES  ON  SURGERY.     1  vol.  8vo.;  cloth.     350pp. 


BIRD  (GOLDING),  A.  M.,  M.  D.,  &c. 
URINARY     DEPOSITS:     THEIR     DIAGNOSIS,    PATHOLOGY,    AND 

THERAPEUTICAL  INDICATIONS.    A  new  and  enlarged  American,  from  the  last  improved 
London  edition.     With  over  sixty  illustrations.     In  one  royal  12mo.  volume,  extra  cloth. 


The  new  edition  of  Dr.  Bird's  work,  though  not 
increased  in  size,  has  been  greatly  modified,  and 
much  of  it  rewritten.  It  now  presents,  in  a  com- 

Sendious  form,  the  gist  of  all  that  is  known  and  re- 
lable  in  this  department.     From  its  terse  style  and 
convenient  size,  it  is  particularly  applicable  to  the 
student,  to  whom  we  cordially  commend  it. —  The 
Medical  Examiner. 

It  can  scarcely  be  necessary  for  us  to  say  anything 
of  the  merits  of  this  well-known  Treatise,  which  so 
admirably  brings  into  practical  application  the  re 


sults  of  those  microscopical  and  chemical  researches 
regarding  the  physiology  and  pathology  of  the  uri 
nary  secretion,  which  have  contributed  so  much  to 
the  increase  of  our  diagnostic  powers,  and  to  th« 
extension  and  satisfactory  employment  of  our  thera 
peutic  resources.  In  the  preparation  of  this  new 
edition  of  his  work,  it  is  obvious  that  Dr.  Goldirig 
Bird  has  spared  no  pains  to  render  it  a  faithful  repre 
sentation  of  the  present  state  of  scientific  knowledge 
'  on  the  subject  it  embraces.—  The  British  and  Foreign 
J\Iftlico-C/iirurgical  Review. 


BY    THE   SAME   AUTHOR. 

ELEMENTS  OF  NATURAL  PHILOSOPHY;  being  an  Experimental  Intro 
duction  to  the  Physical  Sciences.  Illustrated  with  nearly  four  hundred  wood-cuts.  From  the 
third  London  edition.  In  one  neat  volume,  royal  12rao.  pp.  402. 


AND    SCIENTIFIC    PUBLICATIONS. 


BARTLETT  (ELISHA),  M .  D., 

Professor  of  Materia  Medica  and  Medical  Jurisprudence  in  the  College  of  Physicians  and 
Surgeons,  New  York. 

THE   HISTORY,  DIAGNOSIS,   AND   TREATMENT   OF   THE   FEVERS 

OF  THE  UNITED  STATES.     Third  edition,  revised  and  improved.     In  one  octavo  volume, 

of  six  hundred  pages,  beautifully  printed,  and  strongly  bound. 

In  preparing  a  new  edition  of  this  standard  work,  the  author  has  availed  himself  of  such  obser 
vations  and  investigations  as  have  appeared  since  the  publication  of  his  last  revision,  and  he  has 
endeavored  in  every  way  to  render  it  worthy  of  a  continuance  of  the  very  marked  favor  with  which 
it  has  been  hitherto  received. 


The  masterly  and  elegant  treatise,  by  Dr.  Bartlett 
is  invaluable  to  the  American  student  and  practi 
tioner. — Dr.  Holmes' s  Report  to  the  Nat.  Med.  Asso 
ciation. 

We  regard  it,  from  the  examination  we  have  made 
of  it,  the  best  work  on  fevers  extant  in  our  language, 
and  as  such  cordially  recommend  it  to  the  medical 
public. — St.  Louis  Medical  and  Surgical  Journal. 

Take  it  altogether,  it  is  the  most  complete  history 


Of  the  value  and  importance  of  such  a  work,  it  is 
needless  here  to  speak ;  the  profession  of  the  United 
States  owe  much  to  the  author  for  the  very  able 
volume  which  he  has  presented  to  them,  and  for  the 
careful  and  judicious  manner  in  which  he  has  exe 
cuted  his  task.  No  one  volume  with  which  we  are 
acquainted  contains  so  complete  a  history  of  our 
fevers  as  this.  To  Dr.  Bartlett  we  owe  our  best 
thanks  for  the  very  able  volume  he  has  given  us,  as 
embodying  certainly  the  most  complete,  methodical, 


of  our  fevers  which  has  yet  been  published,  and  and  satisfactory  account  of  our  fevers  anywhere  to 
every  practitioner  should  avail  himself  of  its  con-  be  met  with.— The  Charleston  Med.  Journal  and 
tents'. — The  Western  Lancet.  I  Review. 


BUCKLER   (T.   H.),  M .  D., 

Formerly  Physician  to  the  Baltimore  Almshouse  Infirmary,  &c. 

ON  THE  ETIOLOGY,   PATHOLOGY,   AND  TREATMENT   OF   FIBRO- 

BRONCHITIS  AND  RHEUMATIC  PNEUMONIA.     In  one  handsome  octavo  volume,  extra 
cloth.     (Just  Isszied.) 

BOWMAN  (JOHN    E.),  M.D. 
PRACTICAL   HANDBOOK   OF   MEDICAL    CHEMISTRY.     In  one  neat 

volume,  royal  12mo.,  with  numerous  illustrations,     pp.  288. 

BY  THE  SAME  AUTHOR. 

INTRODUCTION    TO    PRACTICAL    CHEMISTRY,    INCLUDING    ANA- 

LYSIS.    With  numerous  illustrations.     In  one  neat  volume,  royal  12mo.     pp.350. 


BARLOW   (GEORGE  H.),    M .  D. 
A  MANUAL  OF  THE  PRINCIPLES  AND  PRACTICE   OF  MEDICINE. 

In  one  octavo  volume.     (Preparing.) 

BEALE  (LIONEL   JOHN),  M.  R.  C.  S.,  &c. 
THE    LAWS   OF    HEALTH   IN   RELATION   TO    MIND    AND   BODY. 

A  Series  of  Letters  from  an  »W  Practitioner  to  a  Patient.     In  one  handsome  volume,  royal  12mo., 
extra  cloth. 


COLOMBAT  DE   L'ISERE. 
A  TREATISE   ON   THE    DISEASES    OF   FEMALES,  and  on  the  Special 

Hygiene  of  their  Sex.    Translated,  with  many  Notes  and  Additions,  by  C.  D.  MEIGS,  M.  D. 

Second  edition,  revised  and  improved.    In  one  large  volume,  octavo,  with  numerous  wood-cuts. 

pp.  720. 

The  treatise  of  M.  Colombat  is  a  learned  and  la-  i  M.  Colombat  De  LTsere  has  not  consecrated  ten 
borious  commentary  on  these  diseases,  indicating  years  of  studious  toil  and  research  to  the  frailer  sex 
very  considerable  research,  great  accuracy  of  judg-  in  vain;  and  although  we  regret  to  hear  it  is  at  the 
ment,  and  no  inconsiderable  personal  experience,  expense  of  health,  he  has  imposed  a  debt  of  gratitude 
With  the  copious  notes  and  additions  of  its  experi-  as  well  upon  the  profession,  as  upon  the  mothers  and 
eiiced  and  very  erudite  translator  and  editor,  Dr.  daughters  of  beautiful' France,  which  that  gallant 
Meigs,  it  presents,  probably,  one  of  the  most  com-  nation  knows  best  how  to  acknowledge. — New  Or- 
plete  and  comprehensive  works  on  the  subject  we  leans  Medical  Journal. 
possess. — American  Med.  Journal.  \ 

COPLAND  (JAMES),  M .  D.,  F.  R.  S.,  £c. 
OF  THE  CAUSES,  NATURE,  AND  TREATMENT  OF  PALSY  AND 

APOPLEXY,  and  of  the  Forms,  Seats,  Complications,  and  Morbid  Relations  oi  Paralytic  and 
Apoplectic  Diseases.     In  one  volume,  royal  12mo.,  extra  cloth,    pp.  326. 

CLYMER  (MEREDITH),  M.  D.,  &c. 
FEVERS;     THEIR    DIAGNOSIS,    PATHOLOGY,    AND    TREATMENT. 

Prepared  and  Edited,  with  large  Additions,  from  the  Essays  on  Fever  in  Tweedie's  Library  of 
Practical  Medicine.     In  one  octavo  volume,  of  600  pages. 

CARSON   (JOSEPH),   M.  D., 

Professor  of  Materia  Medica  and  Pharmacy  in  the  University  of  Pennsylvania. 

SYNOPSIS  OF  THE  COURSE  OF  LECTURES  ON  MATERIA  MEDICA 

AND  PHARMACY,  delivered  in  the  University  of  Pennsylvania.     In  one  very  neat  octavo 
volume,  of  208  pages. 


BLANCHARD  &  LEA'S   MEDICAL 


CARPENTER  (WILLIAM    B.),   M.D.,  F.  R.  S.,  &c., 

Examiner  in  Physiology  and  Comparative  Anatomy  in  the  University  of  London. 

PRINCIPLES  OF  HUMAN  PHYSIOLOGY;  with  their  chief  applications  to 

Psychology,  Pathology,  Therapeutics,  Hygiene,  and  Forensic  Medicine.  Fifth  American,  from 
the  fourth  and  enlarged  London  edition.  With  three  hundred  and  fourteen  illustrations.  Edited, 
with  additions,  by  FRANCIS  GURNEY  SMITH,  M.  D.,  Professor  of  the  Institutes  of  Medicine  in  the 
Pennsylvania  Medical  College,  &c.  In  one  very  large  and  beautiful  octavo  volume,  of  about  1100 
large  pages,  handsomely  printed  and  strongly  bound  in  leather,  with  raised  bands.  New  edition. 
(Lately  Issued.) 

The  most  complete  work  on  the  science  in  our  i      The  best  text-book  in  the  language  on  this  ex- 
language.—  Am.  Med.  Journal.  tensive  subject.— London  Med.  Times. 

A  complete  cyclopaedia  of  this  branch  of  science. 
—N.  Y.  Med.  Times. 


The  most  complete  exposition  of  physiology  which 
any  language  can  at  present  give.— Brit,  and  For. 


Med.-C/iirurg.  Review. 

We  have  thus  adverted  to  some  of  the  leading 
"additions  and  alterations,"  which  have  been  in 
troduced  by  the  author  into  this  edition  of  his  phy 
siology.  These  will  be  found,  however,  very  far  to 
exceed  the  ordinary  limits  of  a  new  edition,  "the 
old  materials  having  been  incorporated  with  the 
new,  rather  than  the  new  with  the  old."  It  now 
certainly  presents  the  most  complete  treatise  on  the 
subject  within  the  reach  of  the  American  reader; 
and  while,  for  availability  as  a  text-book,  we  may 
perhaps  regret  its  growth  in  bulk,  we  are  sure  that 
the  student  of  physiology  will  feel  the  impossibility 
of  presenting  a  thorough  digest  of  the  facts  of  the 
science  within  a  more  limited  compass. — Medical 
Examiner. 

The  greatest,  the  most  reliable,  and  the  best  book 
on  the  subject  which  we  know  of  in  the  English 


The  standard  of  authority  on  physiological  sub- 

!  jects.  *  *  *  In  the  present  edition,  to  particularize 

the  alterations  and  additions  which  have  been  made, 

would  require  a  review  of  the  whole  work,  since 

scarcely  a  subject  has  not  been  revised  and  altered, 

added  to,  or  entirely  remodelled  to  adapt  it  to  the 

present  state  of  the  science.— Charleston  Med.  Journ. 

Any  reader  who  desires  a  treatise  on  physiology 

may  feel   himself  entirely  safe  in  ordering  this. — 

Western  Med.  and  Surg.  Journal. 

From  this  hasty  and  imperfect  allusion  it  will  be 
seen  by  our  readers  that  the  alterations  and  addi 
tions  to  this  edition  render  it  almost  a  new  work — 
and  we  can  assure  our  readers  that  it  is  one  of  the 
best  summaries  of  the  existing  facts  of  physiological 
science  within  the  reach  of  the  English  student  and 
physician. — N.  Y.  Journal  of  Medicine. 
j  The  profession  of  this  country,  and  perhaps  also 
,  have  anxiously  and  for  some  time  awaited 


language.— Stethoscope.  .  the  announcement  of  this  new  edition  of  Carpenter's 

The  most  complete  work  now  extant  in  our  Ian-    Human  Physiology.    His  former  editions  have  for 


guage. — N.  O.  Med.  Register. 

The  changes  are  too  numerous  to  admit  of  an  ex 
tended  notice  in  this  place.  At  every  point  where 
the  recent  diligent  labors  of  organic  chemists  and 
micrographers  have  furnished  interesting  and  valu 
able  facts,  they  have  been  appropriated ,  and  no  pains 
have  been  spared,  in  so  incorporating  and  arranging 


many  years  been  almost  the  only  text-book  on  Phy 
siology  in  all  our  medical  schools,  and  its  circula 
tion  among  the  profession  has  been  unsurpassed  by 
any  work  in  any  department  of  medical  science. 

It  is  quite  unnecessary  for  us  to  speak  of  thig 
work  as  its  merits  would  justify.  The  mere  an 
nouncement  of  its  appearance  will  afford  the  highest 
pleasure  to  every  student  of  Physiology,  while  its 


them  that  the  work  may  constitute  one  harmonious  !  perusal   will   be  of   infinite    service  in    advancing 
system.— Southern  Med.  and  Surg.  Journal.  I  physiological  science.— Ohio  Med.  and  Surg.  Journ. 

BY  THE  SAME  AUTHOR.     (Now  Ready.) 

PRINCIPLES  OF  COMPARATIVE   PHYSIOLOGY.     New  American,  from 

the  Fourth  and  Revised  London  edition.     In  one  large  and  handsome  octavo  volume,  with  over 

three  hundred  beautiful  illustrations. 

The  delay  which  has  existed  in  the  appearance  of  this  work  has  been  caused  by  the  very  thorough 
revision  and  remodelling  which  it  has  undergone  at  the  hands  of  the  author,  and  the  large  number 
of  new  illustrations  which  have  been  prepared  for  it.  It  will,  therefore,  be  found  almost  a  new 
work,  and  fully  up  to  the  day  in  every  department  of  the  subject,  rendering  it  a  reliable  text-book 
for  all  students  engaged  in  this  branch  of  science.  Every  effort  has  been  made  to  render  its  typo 
graphical  finish  and  mechanical  execution  worthy  of  its  exalted  reputation,  and  creditable  to"  the 
mechanical  arts  of  this  country.  A  few  notices  of  the  last  edition  are  appended. 

Without  pretending  to  it,  it  is  an  Encyclopedia  of 
the  subject,  accurate  and  complete  in  all  respects — 
a  truthful  reflection  of  the  advanced  state  at  which 


the   science   has  now  arrived. — Dublin   Quarterly 
Journal  of  Medical  Science. 

A  truly  magnificent  work— in  itself  a  perfect  phy 
siological  study. — Ranking's  Abstract. 

This  work  stands  without  its  fellow.  It  is  one 
few  men  in  Europe  could  have  undertaken  ;  it  is  one 
no  man,  we  believe,  could  have  brought  to  so  suc 
cessful  an  issue  as  Dr.  Carpenter.  It  required  for 
its  production  a  physiologist  at  once  deeply  read  in 
ithe  labors  of  others,  capable  of  taking  a  general, 


critical,  and  unprejudiced  view  of  those  labors,  and 
of  combining  the  varied,  heterogeneous  materials  at 
his  disposal,  so  as  to  form  an  harmonious  whole. 
We  feel  that  this  abstract  can  give  the  reader  a  very 
imperfect  idea  of  the  fulness  of  this  work,  and  no 
idea  of  its  unity,  of  the  admirable  manner  in  which 
material  has  been  brought,  from  the  most  various 
sources,  to  conduce  to  its  completeness,  of  the  lucid 
ity  of  the  reasoning  it  contains,  or  of  the  clearness 
of  language  in  which  the  whole  is  clothed.  Not  the 
profession  only,  but  the  scientific  world  at  large, 
must  feel  deeply  indebted  to  Dr.  Carpenter  for  this 
great  work.  It  must,  indeed,  add  largely  even  to 
his  high  reputation. — Medical  Times. 


BY  THE  SAME  AUTHOR.     (Preparing.) 

THE  MICROSCOPE  AND  ITS  REVELATIONS.     In  one  handsome  volume, 

beautifully  illustrated  with  plates  and  wood-cuts. 

BY  THE  SAME  AUTHOR.     (Preparing.) 

GENERAL  PHYSIOLOGY.     In  one  large  and  very  handsome  octavo  volume; 
with  several  hundred  illustrations. 

The  subject  of  general  physiology  having  been  omitted  in  the  last  edition  of  the  author's  »  Com 
parative  Physiology,"  he  has  undertaken  to  prepare  a  volume  which  shall  present  it  more  tho 
roughly  and  fully  than  has  yet  been  attempted,  and  which  may  be  regarded  as  an  introduction  to 
his  other  works. 


AND    SCIENTIFIC    PUBLICATIONS. 


CARPENTER  (WILLIAM   B-),   M.  D.,  F.  R.  S., 

Examiner  in  Physiology  and  Comparative  Anatomy  in  the  University  of  London. 

ELEMENTS  (OR  MANUAL)  OF  PHYSIOLOGY,  INCLUDING   PHYSIO 

LOGICAL  ANATOMY.    Second  American,  from  a  new  and  revised  London  edition.    With 
one  hundred  and  ninety  illustrations.     In  one  very  handsome  octavo  volume. 

In  publishing  the  first  edition  of  this  work,  its  title  was  altered  from  that  of  the  London  volume, 
by  the  substitution  of  the  word  "  Elements1'  for  that  of  "  Manual,"  and  with  the  author's  sanction 
the  title  of  "Elements"  is  still  retained  as  being  more  expressive  of  the  scope  of  the  treatise.  A 
comparison  of  the  present  edition  with  the  former  one  will  show  a  material  improvement,  the 
author  having  revised  it  thoroughly,  with  a  view  of  rendering  it  completely  on  a  level  with  the 
most  advanced  state  of  the  science.  By  condensing  the  less  important  portions,  these  numerous 
additions  have  been  introduced  without  materially  increasing  the  bulk  of  the  volume,  and  while 
numerous  illustrations  have  been  added,  and  the  general  execution  of  the  work  improved,  it  has 
been  kept  at  its  former  very  moderate  price. 


To  say  that  it  is  the  best  manual  of  Physiology  | 
now  before,  the  public,  would  not  do  sufficient  justice  ' 
to  the  author.  —  Buffalo  Medical  Journal. 

In  his  former  works  it  would  seem  that  he  had 
exhausted  the  subject  of  Physiology.  In  the  present, 
he  gives  the  essence,  as  it  were,  of  the  whole.  —  N.  Y. 
Journal  of  Medicine. 

Those  who  have  occasion  for  an  elementary  trea 
tise  on  Physiology,  cannot  do  better  than  to  possess 
themselves  of  the  manual  of  Dr.  Carpenter.  —  Medical 
Examiner. 


The  best  and  most  complete  expose"  of  modern 
Physiology,  in  one  volume,  extant  in  the  English 
language. — St.  Louis  Medical  Journal. 

With  such  an  aid  in  his  hand,  there  is  no  excuse 
for  the  ignorance  often  displayed  respecting  the  sub 
jects  of  which  it  treats.  From  its  unpretending  di 
mensions,  it  may  not  be  so  esteemed  by  those  anxioug 
to  make  a  parade  of  their  erudition;  but  whoever 
masters  its  contents  will  have  reason  to  be  proud  of 
his  physiological  acquirements.  The  illustrations 
are  well  selected  and  finely  executed. — Dublin  Med. 
Press. 


BY   THE   SAME    AUTHOR. 

A  PRIZE  ESSAY  ON  THE  USE  OF  ALCOHOLIC  LIQUORS  IN  HEALTH 

AND  DISEASE.     New  edition,  with  a  Preface  by  D.  F.  CONDIE,  M.  D.,  and  explanations  of 
scientific  words.     In  one  neat  12mo.  Tolume.     (Now  Ready.) 

This  new  edition  has  been  prepared  with  a  view  to  an  extended  circulation  of  this  important  little 
work,  which  is  universally  recognized  as  the  best  exponent  of  the  laws  of  physiology  and  pathology 
applied  to  the  subject  of  intoxicating  liquors,  in  a  form  suited  both  for  the  profession  and  the  public. 
To  secure  a  wider  dissemination  of  its  doctrines  the  publishers  have  done  up  copies  in  flexible 
cloth,  suitable  for  mailing,  which  will  be  forwarded  through  the  post-office,  free,  on  receipt  of  fifty 
cents.  Societies  and  others  supplied  in  quantities  for  distribution  at  a  liberal  deduction. 


CHELIUS   (J.  M.),    M.  D., 

Professor  of  Surgery  in  the  University  of  Heidelberg,  &c. 

A  SYSTEM  OF  SURGERY.  Translated  from  the  German,  and  accompanied 
with  additional  Notes  and  References,  by  JOHN  F.  SOUTH.  Complete  in  three  very  large  octavo 
volumes,  of  nearly  2200  pages,  strongly  bound,  with  raised  bands  and  double  titles. 


We  do  not  hesitate  to  pronounce  it  the  best  and 
most  comprehensive  system  of  modern  surgery  with 
which  we  are  acquainted. — Medico-Chirurgical  Re 
view  . 

The  fullest  and  ablest  digest  extant  of  all  that  re 
lates  to  the  present  advanced  state  of  surgical  pa 
thology. — American  Medical  Journal. 

As  complete  as  any  system  of  Surgery  can  well 
be. — Southern  Medical  and  SurgicalJournal. 


The  most  learned  and  complete  systematic  treatise 
now  extant. — Edinburgh  Medical  Journal. 

A  complete  encyclopaedia  of  surgical  science — a 
very  complete  surgical  library — by  far  the  most 
complete  and  scientific  system  of  surgery  in  the 
English  language. — N.  Y.  Journal  of  Medicine. 

The  most  extensive  and  comprehensive  account  of 
the  art  and  science  of  Surgery  in  our  language. — 
Lancet. 


CHRISTISON  (ROBERT),  M.  D.,  V.  P.  R.  S.  E.,  &c. 
A  DISPENSATORY;  or.  Commentary  on  the  Pharmacopoeias  of  Great  Britain 

and  tho  United  States;  comprising  the  Natural  History,  Description,  Chemistry,  Pharmacy,  Ac 
tions,  Uses,  and  Doses  of  the  Articles  of  the  Materia  Medica.  Second  edition,  revised  and  im 
proved,  with  a  Supplement  containing  the  most  important  New  Remedies.  With  copious  Addi 
tions,  and  two  hundred  and  thirteen  large  wood-engravings.  By  11.  EGLESFELD  GRIFFITH,  M.  D. 
In  one  very  large  and  handsome  octavo  volume,  of  over  1000  pages. 


It  is  not  needful  that  w»,  should  compare  it  with 
the  other  pharmacopoeias  extant,  which  enjoy  and 
merit  the  confidence  of  the  profession  :  it  is  enough 
to  say  that  it  appears  to  us  as  perfect  as  a  Dispensa 
tory,  in  the  present  state  of  pharmaceutical  science, 
could  be  made.  If  it  omits  any  details  pertaining  to 
this  branch  of  knowledge  which  the  student  has  a 
right  to  expect  in  such  a  work,  we  confess  the  omis 
sion  has  escaped  our  scrutiny.  We  cordially  recom 
mend  this  work  to  such  of  our  readers  as  are  in  need 
of  a  Dispensatory.  They  cannot  make  choice  of  a 
better. —  Western  Journ.  of  Medicine  and  Surgery. 


There  is  not  in  any  language  a  more  complete  and 
perfect  Treatise. — N.  Y.  Annalist. 

In  conclusion,  we  need  scarcely  say  that  we 
strongly  recommend  this  work  to  all  classes  of  our 
readers.  Asa  Dispensatory  and  commentary  on  the 
Pharmacopoeias,  it  is  unrivalled  in  the  English  or 
any  other  language. — The  Dublin  Quarterly  Journal. 

We  earnestly  recommend  Dr.  Christison's  Dis 
pensatory  to  all  our  readers,  as  an  indispensable 
companion,  not  in  the  Study  only,  but  in  the  Surgery 
also. — British  and  Foreign  Medical  Review. 


8  BLANCHARD   &  LEA'S  MEDICAL 

CONDIE  (D.  F.),  M.  D.,  fitc. 
A  PRACTICAL  TREATISE  ON  THE  DISEASES  OF  CHILDREN.    Fourth 

edition,  revised  and  augmented.  In  one  large  volume,  Svo.,  of  nearly  750  pages.  (Just  Issued.) 
FROM  THE  AUTHOR'S  PREFACE. 

The  demand  for  another  edition  lias  afforded  the  author  an  opportunity  of  again  subjecting  the 
entire  treatise  to  a  careful  revision,  and  of  incorporating  in  it  every  important  observation  recorded 
since  the  appearance  of  the  last  edition,  in  reference  to  the  pathology  and  therapeutics  of  the  several 
diseases  of  which  it  treats. 

In  the  preparation  of  the  present  edition,  as  in  those  which  have  preceded,  while  the  author  has 
appropriated  to  his  use  every  important  fact  that  he  has  found  recorded  in  the  works  of  others, 
having  a  direct  bearing  upon  either  of  the  subjects  of  which  he  treats,  and  the  numerous  valuable 
observations — pathological  as  well  as  practical — dispersed  throughout  the  pages  of  the  medical 
journals  of  Europe  and  America,  he  has,  nevertheless,  relied  chiefly  upon  his  own  observations  and 
experience,  acquired  during  a  long  and  somewhat  extensive  practice,  and  under  circumstances  pe 
culiarly  well  adapted  for  the  clinical  study  of  the  diseases  of  early  life. 

Every  species  of  hypothetical  reasoning  has,  as  much  as  possible,  been  avoided.  The  author  has 
endeavored  throughout  the  work  to  confine  himself  to  a  simple  statement  of  well-ascertained  patho 
logical  facts,  and  plain  therapeutical  directions — his  chief  desire  being  to  render  it  what  its  title 
imports  it  to  be,  A  PRACTICAL  TREATISE  ON  THE  DISEASES  OF  CHILDREN. 


Dr.  Condiers  scholarship,  acumen?  industry,  and 
practical  sense  are  manifested  in  this,  as  in  all  his 
numerous  contributions  to  science. — Dr.  Hoi 


mes's 


"We  feel  assured  from  actual  experience  that  no 
physician's  library  can  be  complete  without  a  copy 
of  this  work. — N.  Y.  Journal  of  Medicine. 
Report  to  the  American  Medical  Association. 

_.       _      ,.   .          A  veritable  pacdiatnc  encA'clopoedia,  and  an  honor 

Taken  as  a  whole,  in  our  judgment,  Dr.  Condies  _..'__-..- 

Treatise  is  the  one  from  the  perusal  of  which  the 


practitioner  in  this  country  will  rise  with  the  great 
est  satisfaction  — Western  Journal  of  Medicine  and 
Surgery. 

One  of  the  best  works  upon  the  Diseases  of  Chil 
dren  in  the  English  language. — Western  Lancet. 

Perhaps  the  most  full  and  complete  \york  now  be 


to  American  medical  literature. — Ohio  Medical  and 
Surgical  Journal. 


We  feel  persuaded  that  the  American  medical  pro 
fession  will  soon  regard  it  not  only  as  a  very  good, 
but  as  the  VERY  BEST  "Practical  Treatise  on  the 
Diseases  of  Children." — American  Medical  Journal. 

We  pronounced  the  first  edition  to  be  the  best 


fore  the  profession  of  the  United  States;  indeed,  we 

may  say  in  the  English  language.    It  is  vastly  supe-    language,   and,  notwithstanding  all  that  has   been 

rior  to  most  of  its  predecessors. — Transylvania  Mud.  j  published,  we  still  regard  it  in  that  light. — Medical 


COOPER  (BRANSBY   B.),  F.  R.  S., 

Senior  Surgeon  to  Guy's  Hospital,  &c. 

LECTURES  ON  THE   PRINCIPLES   AND   PRACTICE   OF   SURGERY. 

In  one  very  large  octavo  volume,  of  750  pages.    (Lately  Issued.) 

For  twenty-five  years  Mr.  Bransby  Cooper  has  I  Cooper's  Lectures  as  a  most  valuable  addition  to 
been  surgeon  to  Guy's   Hospital;    and  the  volume  |  our  surgical  literature,  and  one  which  cannot  fail 


before  us  may  be  said  to  consist  of  an  account  of 
the  results  of  his  surgical  experience  during  that 
long  period.  We  cordially  recommend  Mr.  Bransby 


to  be  of  service  both  to  students  and  to  those  who 
are  actively  engaged  in  the  practice  of  their  profes 
sion. — The  Lancet. 


COOPER  (SIR  ASTLEY   P.),   F.  R.  S.,  &c. 
A  TREATISE  ON  DISLOCATIONS  AND  FRACTURES  OF  THE  JOINTS. 

Edited  by  BRANSBY  B.  COOPER,  F.  R.  S.,  &c.  With  additional  Observations  by  Prof.  J.  C. 
WARREN.  A  new  American  edition.  In  one  handsome  octavo  volume,  with  numerous  illustra 
tions  on  wood. 

BY    THE    SAME    AUTHOR. 

ON  THE  ANATOMY  AND  TREATMENT  OF  ABDOMINAL  HERNIA. 

One  large  volume,  imperial  Svo.,  with  over  130  lithographic  figures. 

BY   THE   SAME    AUTHOR. 

ON   THE   STRUCTURE   AND   DISEASES    OF  THE  TESTIS,  AND  OX 

THE  THYMUS  GLAND.     One  vol.  imperial  Svo.,  with  177  figures,  on  29  plates. 

BY    THE    SAME    AUTHOR. 

ON  THE  ANATOMY  AND  DISEASES  OF  THE  BREAST,  with  twenty- 
five  Miscellaneous  and  Surgical  Papers.  One  large  volume,  imperial  8vo.,  with  252  figures,  on 
GO 


These  last  three  volumes  complete  the  surgical  writings  of  Sir  Astley  Cooper.  They  are  very 
handsomely  printed,  with  a  large  number  oi  lithographic  plates,  executed  in  the  best  style,  and  are 
presented  at  exceedingly  low  prices. 


AND    SCIENTIFIC    PUBLICATIONS. 


CHURCHILL  (FLEETWOOD),  M .  D.,  M.  R.  I.  A. 
ON  THE  THEORY  AND  PRACTICE  OF  MIDWIFERY.  A  new  American, 

from  the  last  and  improved  English  edition.  Edited,  with  Notes  and  Additions,  by  D.  FKAJJCIS 
CONDIE,  M.  D.,  author  of  a  "Practical  Treatise  on  the  Diseases  of  Children,"  &c.  With  139 
illustrations.  In  one  very  handsome  octavo  volume,  pp.  510.  (Lately  Issued.) 

To  bestow  praise  on  a  book  that  has  received  sucli  No  work  holds  a  higher  position,  or  is  more  de- 
marked  approbation  would  be  superfluous.  AVe  need  serving  of  being  placed  in  the  hands  of  tho  tyro, 
only  sav,  therefore,  that  if  the  first  edition  was  |  the  advanced  student,  or  the  practitioner. — Medical 

"--     Examiner. 

Previous  editions,  under  the  editorial  supervision 
of  Prof    R.  M.  Huston,  have  been   received  with. 
;rved  it ;  but  this,  re- 
blin  edition,  carefully 

revised  and  brought  up  by  the  author  to  the  present 
time,  does  present  an  unusually  accurate  and  able 
exposition  of  every  important  particular  embraced 
in  the  department  of  midwifery.  *  %?  The  clearness, 
directness,  and  precision  of  its  teachings,  together 
with  the  great  amount  of  statistical  research  which 
its  text  exhibits,  have  served  to  place  it  already  in 
the  foremost  rank  of  works  in  this  department  of  re 
medial  science. — N.  O.  Med.  and  Surg.  Journal. 


thought"  worthy   of  a   favorable   reception   by   the 

medical  public,  we  can  confidently  affirm  that  this 

will   be   found  much   more  so.     The  lecturer,   the 

practitioner,  and  the  student,  may  all  have  recourse    of  Prof    R.  M.  Huston,  have 

to  its  pages,  and  derive  from  their  perusal  much  in-  I  marked  favor,  and  they  deser 

terest  and  instruction  in  everything  relating  to  theo-    printed  from  a  very  late  Dub: 

retical  and  practical  midwifery. — Dublin  Quarterly 

Journal  of  Medical  Science. 

A  work  of  very  great  merit,  and  such  as  we  can 
confidently  recommend  to  the  study  of  every  obste 
tric  practitioner. — London  Medical  Gazette. 

This  is  certainly  the  most  perfect  system  extant. 
It  is  the  best  adapted  for  the  purposes  of  a  text 
book,  and  that  which  he  whose  necessities  confine 
him  to  one  book,  should  select  in  preference  to  all 
others. — Southern  Medical  and  Surgical  Journal. 

The  most  popular  -work  on  midwifery  ever  issue 
from  the  American  press. — Charleston  Med.  Journal.  \  guage.— Monthly  Journal  of  Medical  Science. 


In  our  opinion,  it  forms  one  of  the  best  if  not  the 
very  best  text-book  and  epitome  of  obstetric  science 
d    which  we  at  present  possess  in  the  English   Ian- 


Were  we  reduced  to  the  necessity  of  having  but 
one  work  on  midwifery,  and  permitted  to  choose,  i 
we  would  unhesitatingly  take  Churchill. — Western 
Med.  and  Surg.  Journal. 

It  is  impossible  to  conceive  a  more  useful  and 
elegant  manual  than  Dr.  Churchill's  Practice  of 
Midwifery. — Provincial  Medical  Journal. 

Certainly,  in  our  opinion,  the  very  best  work  on 
the  subject  which  exists. — N.  Y.  Annalist. 


The  clearness  and  precision  of  style  in  which  it  is 
written,  and  the  great  amount  of  statistical  research 
which  it  contains,  have  served  to  place  it  in  the  first 
rank  of  works  in  this  department  of  medical  science. 
—  N.  Y.  Journal  of  Medicine. 

Few  treatises  will  be  found  better  adapted  as  a 
text-book  for  the  student,  or  as  a  manual  for  the 
frequent  consultation  of  the  young  practitioner. — 
American  Medical  Journal. 


BY   THE    SAME    AUTHOR. 


ON  THE  DISEASES  OF  INFANTS  AND  CHILDREN. 

handsome  volume  of  over  600  pages. 


In  one  large  and 


eg 

to  completeness  than  any  other  of  the  kind  with 
which  we  are  acquainted.  Most  cordially  and  earn 
estly,  therefore,  do  we  commend  it  to  our  profession 
al  brethren,  and  we  feel  assured  that  the  stamp  of 
their  approbation  will  in  due  time  be  impressed  upon 
it.  After  an  attentive  perusal  of  its  contents,  we 
hesitate  not  to  say,  that  it  is  one  of  the  most  com 
prehensive  ever  written  upon  the  diseases  of  chil 
dren,  and  that,  for  copiousness  of  reference,  extent  of 
research,  and  perspicuity  of  detail,  it  is  scarcely  to 
be  equalled,  and  not  to  be  excelled,  in  any  lan 
guage. — Dublin  Quarterly  Journal. 

After  this  meagre,  and  we  know,  very  imperfect 
notice  of  Dr.  Churchill's  work,  we  shall  conclude 
by  saying,  that  it  is  one  that  cannot  fail  from  its  co 
piousness,  extensive  research,  and  general  accuracy, 
to  exalt  still  higher  the  reputation  of  the  author  in 
this  country.  The  American  reader  will  be  particu 
larly  pleased  to  find  that  Dr.  Churchill  has  done  full 
justice  throughout  his  work  to  the  various  American 
authors  on  this  subject.  The  names  of  Dewees, 
Eberle,  Condie,  and  Stewart,  occur  on  nearly  every 
page,  and  these  authors  are  constantly  referred  to  by 
tiie  author  in  terms  of  the  highest  praise,  and  with 
the  most  liberal  courtesy. — The  Medical  Examiner. 


The  present  volume  will  sustain  the  reputation 
acquired  by  the  author  from  his  previous  works. 
The  reader  will  find  in  it  full  and  judicious  direc 
tions  for  the  management  of  infants  at  birth,  and  a 
compendious,  but  clear  account  of  the  diseases  to 
which  children  are  liable,  and  the  most  successful 
mode  of  treating  them.  We  must  not  close  this  no 
tice  without  calling  attention  to  the  authors  style, 
which  is  perspicuous  and  polished  to  a  degree,  we 
regret  to  say,  not  generally  characteristic  of  medical 
works.  We  recommend  the  work  of  Dr.  Churchill 
most  cordially,  both  to  students  and  practitioners, 
as  a  valuable  and  reliable  guide  in  the  treatment  of 
the  diseases  of  children. — Am.  Journ.  of  the  Med. 
Sciences. 

We  know  of  no  work  on  this  department  of  Prac 
tical  Medicine  which  presents  so  candid  and  unpre 
judiced  a  statement  or  posting  up  of  our  actual 
knowledge  as  this. — N.  Y.  Journal  of  Medicine. 

Its  claims  to  merit  both  as  a  scientific  and  practi 
cal  work,  are  of  the  highest  order.  Whilst  we 
would  not  elevate  it  above  every  other  treatise  on 
the  same  subject,  we  certainly  believe  that  very  few 
are  equal  to  it,  and  none  superior. — Southern  Med. 
and  Surgical  journal. 


BY   THE   SAME   AUTHOR. 


ESSAYS  ON  THE  PUERPERAL  FEVER,  AND  OTHER  DISEASES  PE 
CULIAR  TO  WOMEN.  Selected  from  the  writings  of  British  Authors  previous  to  the  close  of 
the  Eighteenth  Century.  In  one  neat  octavo  volume,  of  about  four  hundred  and  fifty  pages. 

To  these  papers  Dr.  Churchill  has  appended  notes,  !  demies  of  that  disease.  The  whole  forms  a  very 
embodying  whatever  information  has  been  laid  be-  |  valuable  collection  of  papers,  by  professional  writers 
fore  the  profession  since  their  authors'  time.  He  has  |  of  eminence,  on  some  of  the  most  importantaecidents 
also  prefixed  to  the  Essays  on  Puerperal  Fever,  to  which  the  puerperal  female  is  liable. — American 
which  occupy  the  larger  portion  of  the  volume,  an 


interesting   historical  "sketch  of  the  principal  epi- 


Journal  of  Medical  Sciences. 


10 


BLANCHARD    &    LEA'S    MEDICAL 


CHURCHILL  (FLEETWOOD),    M .  D.,  M .  R.  I .  A.,    &c. 

ON  THE  DISEASES  OF  WOMEN;  including  those  of  Pregnancy  and  Child 
bed.  A  new  American  edition,  revised  by  the  Author.  With  Notes  and  Additions,  by  D  FRAN 
CIS  CONDIE,  M.  D.,  author  of  "A  Practical  Treatise  on  the  Diseases  of  Children."  In  one  large 
and  handsome  octavo  volume,  with  wood-cuts,  pp.  684.  (Just  Issued.) 

From  the  Author's  Preface. 

In  reviewing  this  edition,  at  the  request  of  my  American  publishers,  I  have  inserted  several  new 
sections  and  chapters,  and  I  have  added,  I  believe,  all  the  information  we  have  derived  from  recent 
researches;  in  addition  to  which  the  publishers  have  been  fortunate  enough  to  secure  the  services 
of  an  able  and  highly  esteemed  editor  in  Dr.  Condie. 


"We  now  regretfully  take  leave  of  Dr.  Churchill's 
book.  Had  our  typographical  limits  permitted,  we 
should  gladly  have  borrowed  more  from  its  richly 
stored  pages.  In  conclusion,  we  heartily  recom 
mend  it  to  the  profession,  and  would  at  the  same 
time  express  our  firm  conviction  that  it  will  not  only 
add  to  the  reputation  of  its  author,  but  will  prove  a 
work  of  great  and  extensive  utility  to  obstetric 
practitioners. — Dublin  Medical  Press. 

Former  editions  of  this  work  have  been  noticed  in 
previous  numbers  of  the  Journal.  The  sentiments  of 
high  commendation  expressed  in  those  notices,  have 
only  to  be  repeated  in  this;  not  from  the  fact  that 
the  profession  at  large  are  not  aware  of  the  high 
merits  which  this  work  really  possesses,  but  from  a 
desire  to  see  the  principles  and  doctrines  therein 
contained  more  generally  recognized,  and  more  uni 


versally  carried  out  in  practice. 
Medicine. 


-N.  Y.  Journal  of 


AVe  know  of  no  author  who  deserves  that  appro 
bation,  on  "the  diseases  of  females,"  to  the  same 
extent  that  Dr.  Churchill  does.  His,  indeed,  is  the 
only  thorough  treatise  we  know  of  on  the  subject; 
and  it  may  be  commended  to  practitioners  and  stu 
dents  as  a  masterpiece  in  its  particular  department. 
The  former  editions  of  this  work  have  been  com 
mended  strongly  in  this  journal,  and  they  have  won 
their  way  to  an  extended,  and  a  well-deserved  popu 


larity.  This  fifth  edition,  before  us.  is  well  calcu 
lated  to  maintain  Dr.  Churchill's  high  reputation. 
It  was  revised  and  enlarged  by  the  author,  for  his 
American  publishers,  and  it  seems  to  us  that  there  is 
scarcely  any  species  of  desirable  information  on  its 
subjects  that  may  not  be  found  in  this  work. — The 
Western  Journal  of  Medicine  and  Surgery. 

We  are  gratified  to  announce  a  new  and  revised 
edition  of  Dr.  Churchill's  valuable  work  on  the  dis 
eases  of  females  We  have  ever  regarded  it  as  one 
of  the  very  best  works  on  the  subjects  embraced 
within  its  scope,  in  the  English  language;  and  the 
present  edition,  enlarged  and  revised  by  the  author, 
renders  it  still  more  entitled  to  the  confidence  of  the 
profession.  The  valuable  notes  of  Prof.  Huston 
have  been  retained,  and  contribute,  in  no  small  de 
gree,  to  enhance  the  value  of  the  work.  It  is  a 
source  of  congratulation  that  the  publishers  have 
permitted  the  author  to  be,  in  this  instance,  his 
own  editor,  thus  securing  all  the  revision  which 
an  author  alone  is  capable  of  making. — The  Western 
Lancet. 

Asa  comprehensive  manual  for  students,  or  a 
work  of  reference  for  practitioners,  we  only  speak 
with  common  justice  when  we  say  that  it  surpasses 
any  other  that  has  ever  issued  on  the  same  sub 
ject  from  the  British  press. — The  Dublin  Quarterly 
Journal. 


DEWEES   (W.    P.),    M.D.,    &c. 
A   COMPREHENSIVE   SYSTEM  OF   MIDWIFERY.     Illustrated   by   occa- 

sional  Cases  and  many  Engravings.     Twelfth  edition,  with  the  Author's  last  Improvements  and 
Corrections.     In  one  octavo  volume,  of  600  pages.     (Just  Issued.) 

BY   THE   SAME    AUTHOR. 

A  TREATISE  ON  THE  PHYSICAL  AND  MEDICAL  TREATMENT  OF 

CHILDREN.     Tenth  edition.     In  one  volume,  octavo,  548  pages.     (Just  Issued.) 

BY    THE    SAME    AUTHOR. 

A  TREATISE  ON   THE   DISEASES   OF   FEMALES.     Tenth   edition. 

one  volume,  octavo,  532  pages,  with  plates.     (Just  Issued.) 


In 


DICKSON    (S.    H.),    M.  D., 

Professor  of  Institutes  and  Practice  of  Medicine  in  the  Medical  College  of  South  Carolina;  late  Professor 

of  the  Institutes  and  Practice  of  Medicine  in  the  Medical  Department  of  the 

University  of  New  York,  &c.  &c. 


ELEMENTS  OF  MEDICINE;  A  Treatise  on  Pathology  and  Therapeutics. 

one  large  and  handsome  octavo  volume.  (Preparing.) 


In 


DANA   (JAMES    D). 
ZOOPHYTES  AND  CORALS.     In  one  volume,  imperial  quarto,  extra  cloth, 

with  wood-cuts. 


ALSO, 


AN  ATLAS  TO  THE  ABOVE,  one  volume,  imperial  folio,  with  sixty-one  mag 
nificent  plates,  colored  after  nature.     Bound  in  half  morocco. 


ALSO, 


ON    THE    STRUCTURE    AND    CLASSIFICATION    OF    ZOOPHYTES. 

Sold  separate,  one  vol.,  cloth. 


DE    LA    BECHE   (SIR    HENRY    T.),   F.  R.  S.,  &c. 
THE  GEOLOGICAL  OBSERVER.     In  one  very  large   and  handsome  octavo 

volume,  of  700  pages.     With  over  three  hundred  wood-cuts.     (Lately  Issued.) 


AND    SCIENTIFIC    PUBLICATIONS. 


11 


DRUITT   (ROBERT),    M.R.  C.S.,   &c. 
THE  PRINCIPLES  AND  PRACTICE   OF  MODERN   SURGERY.     A  new 

American,  from  the  improved  London  edition.     Edited  by  F.  W.  SARGENT,  M.  D.,  author  of 


Minor  Surgery.' 


Illustrated  with  one  hundred  and  ninety-three  wood-engravings.     In 


one  very  handsomely  printed  octavo  volume,  of  576  large  pages. 


Dr.  Druitt's  researches  into  the  literature  of  his 
subject  have  been  not  only  extensive,  but  well  di 
rected  ;  the  most  discordant  authors  are  fairly  and 
impartially  quoted,  and,  while  due  credit  is  given 
to  each,  their  respective  merits  are  weighed  with 
an  unprejudiced  hand.  The  grain  of  wheat  is  pre 
served,  and  the  chaff  is  unmercifully  stripped  otf. 
The  arrangement  is  simple  and  philosophical,  and 
the  style,  though  clear  and  interesting,  is  so  precise, 
that  the  book  contains  more  information  condensed 
into  a  few  words  than  any  other  surgical  work  with 
which  we  are  acquainted. — London  Medical  Times 
and  Gazette,  February  18,  1654. 

No  work,  in  our  opinion,  equals  it  in  presenting 
so  much  valuable  surgical  matter  in  so  small  a 
compass. — St.  Louis  Med.  and  Surgical  Journal. 

Druitt's  Surgery  is  too  well  known  to  the  Ameri 
can  medical  profession  to  require  its  announcement 
anywhere.  Probably  no  work  of  the  kind  has  ever 
been  more  cordially  received  and  extensively  circu 
lated  than  this.  The  fact  that  it  comprehends  in  a 
comparatively  small  compass,  all  the  essential  ele 
ments  of  theoretical  and  practical  Surgery — that  it 
is  found  to  contain  reliable  and  authentic  informa 
tion  on  the  nature  and  treatment  of  nearly  all  surgi 
cal  affections — is  a  sufficient  reason  for  the  liberal 
patronage  it  has  obtained.  The  editor,  Dr.  F.  W. 
Sargent,  has  contributed  much  to  enhance  the  value 
of  the  work,  by  such  American  improvements  as  are 
calculated  more  perfectly  to  adapt  it  to  our  own 
views  and  practice  in  this  country.  It  abounds 
everywhere  with  spirited  and  life-like  illustrations, 
which  to  the  young  surgeon,  especially,  are  of  no 
minor  consideration.  Every  medical  man  frequently 
needs  just  such  a  work  as  this,  for  immediate  refe 
rence  in  moments  of  sudden  emergency,  when  he  has 
not  time  to  consult  more  elaborate  treatises.— The 
Ohio  Medical  and  Surgical  Journal. 

The  author  has  evidently  ransacked  every  stand 
ard  treatise  of  ancient  and  modern  times,  and  all  that 


is  really  practically  useful  at  the  bedside  will  be 
found  in  a  form  at  once  clear,  distinct,  and  interest 
ing. — Edinburgh  Monthly  Medical  Journal. 

Druitt's  work,  condensed,  systematic,  lucid,  and 
practical  as  it  is,  beyond  most  works  on  Surgery 
accessible  to  the  American  student,  has  had  much 
currency  in  this  country,  and  under  its  present  au 
spices  promises  to  rise  to  yet  higher  favor. — The 
Western  Journal  of  Medicine  and  Surgery. 

The  most  accurate  and  ample  resum&  of  the  pre 
sent  state  of  Surgery  that  we  are  acquainted  with. — 
Dublin  Medical  Journal. 

A  better  book  on  the  principles  and  practice  of 
Surgery  as  now  understood  in  England  and  America, 
has  not  been  given  to  the  profession. — Boston  Medi 
cal  and  Surgical  Journal. 

An  unsurpassable  compendium,  not  only  of  Sur 
gical,  but  of  Medical  Practice. — London  Medical 
Gazette. 

This  work  merits  our  warmest  commendations, 
and  we  strongly  recommend  it  to  young  surgeons  as 
an  admirable  digest  of  the  principles  and  practice  of 
modern  Surgery. — Medical  Gazette. 

It  maybe  said  with  truth  that  the  work  of  Mr. 
Druitt  affords  a  complete,  though  brief  and  con 
densed  view,  of  the  entire  field  of  modern  surgery. 
We  know  of  no  work  on  the  same  subject  having  the 
appearance  of  a  manual,  which  includes  so  many 
topics  of  interest  to  the  surgeon  ;  and  the  terse  man 
ner  in  which  each  has  been  treated  evinces  a  most 
enviable  quality  of  mind  on  the  part  of  the  author, 
who  seems  to  have  an  innate  power  of  searching 
out  and  grasping  the  leading  facts  and  features  of 
the  most  elaborate  productions  of  the  pen.  It  is  a 
useful  handbook  for  the  practitioner,  and  we  should 
deem  a  teacher  of  surgery  unpardonable  who  did  not 
recommend  it  to  his  pupils.  In  our  own  opinion,  it 
is  admirably  adapted  to  the  wants  of  the  student. — 
Provincial  Medical  and  Surgical  Journal. 


DUNGLISON,    FORBES,   TWEEDIE,   AND   CONOLLY. 
THE  CYCLOPAEDIA  OF  PRACTICAL  MEDICINE:  comprising  Treatises  on 

the  Nature  and  Treatment  of  Diseases,  Materia  Medica,  and  Therapeutics,  Diseases  of  Women 
and  Children,  Medical  Jurisprudence,  &c.  &c.  In  four  large  super  royal  octavo  volumes,  of 
3254  double-columned  pages,  strongly  and  handsomely  bound. 

*^*  This  work  contains  no  less  than  four  hundred  and  eighteen  distinct  treatises,  contributed  by 
sixty-eight  distinguished  physicians. 

j  unquestionably  one  of  very  great  value  to  the  prac 
titioner.  This  estimate  of  it  has  not  been  formed 
from  a  hasty  examination,  but  after  an  intimate  ac 
quaintance  derived  from  frequent  consultation  of  it 
during  the  past  nine  or  ten  years.  The  editors  are 
practitioners  of  established  reputation,  and  the  list 
of  contributors  embraces  many  of  the  most  eminent 
professorsand  teachers  of  London,  Edinburgh,  Dub 
lin,  and  Glasgow.  It  is,  indeed,  the  great  merit  of 
this  work  that  the  principal  articles  have  been  fur 
nished  by  practitioners  who  have  not  only  devoted 
especial  attention  to  the  diseases  about  which  they 
have  written,  but  have  also  enjoyed  opportunities 
for  an  extensive  practical  acquaintance  with  them, 
and  whose  reputation  carries  the  assurance  of  their 
competency  justly  to  appreciate  the  opinions  of 
others,  while  it  stamps  their  own  doctrines  with 
high  and  just  authority. — American  Medical  Journ. 


The  most  complete  work  on  Practical  Medicine 
extant;  or,  at  least,  in  our  language.—  Buffalo 
Medical  and  Surgical  Journal. 

For  reference,  it  is  above  all  price  to  every  prac 
titioner. — Western  Lancet. 

One  of  the  most  valuable  medical  publications  of 
the  da}- — as  a  work  of  reference  it  is  invaluable. — 
Western  Journal  of  Medicine  and  Surgery. 

It  has  been  to  us,  both  as  learner  and  teacher,  a 
work  for  ready  and  frequent  reference,  one  in  which 
modern  English  medicine  is  exhibited  in  the  most 
advantageous  light.— Medical  Examiner. 

We  rejoice  that  this  work  is  to  be  placed  within 
the  reach  of  the  profession  in  this  country,  it  being 


DUNGLISON    (ROBLEY),    M.D., 

Professor  of  the  Institutes  of  Medicine  in  the  Jefferson  Medical  College,  Philadelphia. 

HUMAN  HEALTH;  or,  the  Influence  of  Atmosphere  and  Locality,  Change  of 

Air  and  Climate,  Seasons,  Food,  Clothing,  Bathing,  Exercise,  Sleep,  fcc.  &c.,  on  Healthy  Man ; 
constituting  Elements  of  Hygiene.  Second  edition,  with  many  modifications  and  additions.  In 
one  octavo  volume,  of  464  pages. 


12 


BLANC  HARD    &    LEA'S   MEDICAL 


DUNGLISON    (ROBLEY),    M.D., 

Professor  of  Institutes  of  Medicine  in  the  Jefferson  Medical  College,  Philadelphia. 

MEDICAL   LEXICON;    a  Dictionary  of  Medical  Science,  containing  a  concise 

Explanation  of  the  various  Subjects  and  Terms  of  Physiology,  Pathology,  Hygiene,  Therapeutics, 
Pharmacology,  Obstetrics,  Medical  Jurisprudence,  &rc.  With  the  French  and  other  Synonymes  ; 
Notices  of  Climate  and  of  celebrated  Mineral  Waters;  Formulae  for  various  Officinal,  Emp'irical, 
and  Dietetic  Preparations,  etc.  Eleventh  edition,  revised.  In  one  very  thick  octavo  volume,  of 
over  nine  hundred  large  double-columned  pages,  strongly  bound  in  leather,  with  raised  bands. 
(Just  Issued.) 

Every  successive  edition  of  this  work  bears  the  marks  of  the  industry  of  the  author,  and  of  his 
detenni'nation  to  keep  it  fully  on  a  level  with  the  most  advanced  state  of  medical  science.  Thus 
nearly  FIFTEEN  THOUSAND  WORDS  have  been  added  to  it  within  the  last  few  years.  As  a  complete 
Medical  Dictionary,  therefore,  embracing  over  FIFTY  THOUSAND  DEFINITIONS,  in  all  the 
branches  of  the  science,  it  is  presented  as  meriting  a  continuance  of  the  great  favor  and  popularity 
which  have  carried  it,  within  no  very  long  space  of  time,  to  an  eleventh  edition. 

Every  precaution  has  been  taken  in  the  preparation  of  the  present  volume,  to  render  its  mecha 
nical  execution  and  typographical  accuracy  worthy  of  its  extended  reputation  and  universal  use. 
The  very  extensive  additions  have  been  accommodated,  without  materially  increasing  the  bulk  of 
the  volume  by  the  employment  of  a  small  but  exceedingly  clear  type,  cast  for  this  purpose.  The 
press  has  been  watched  with  great  care,  and  every  effort  used  to  insure  the  verbal  accuracy  so  ne 
cessary  to  a  work  of  this  nature.  The  whole  is  printed  on  fine  white  paper  ;  and,  while  thus  exhi 
biting  in  every  respect  so  great  an  improvement  over  former  issues,  it  is  presented  at  the  original 
exceedingly  low  price. 

AVe  welcome  it  cordially  ;  it  is  an  admirable  work,  '  valuable  work,  we  directed  the  attention  of  our 
and  indispensable  to  all  literary  medical  men.  The 
labor  which  has  been  bestowed  upon  it  is  something 
prodigious.  The  work,  however,  has  now  been 
done,  and  we  are  happy  in  the  thought  that  no  hu 
man  being  will  have  again  to  undertake  the  same 
gigantic  task.  Revised  and  corrected  from  time  to 
time,  Dr.  Dunglison's  "  Medical  Lexicon"  will  last 
for  centuries. — British  and  Foreign  Med.  Chirurg. 
Revieiv,  July,  1S53. 

The  fact  that  this  excellent  and  learned  work  has 


readers  to  its  peculiar  merits;  and  we  need  do 
little  more  than  state,  in  reference  to  the  present 
reissue,  that,  notwithstanding  the  large  additions 
previously  made  to  it,  no  fewer  than  four  thou 
sand  terms,  not  to  be  found  in  the  preceding  edi 
tion,  are  contained  in  the  volume  before  us. — 
Whilst  it  is  a  wonderful  monument  of  its  author's 
erudition  and  industry,  it  is  also  a  work  of  great 
practical  utility,  as  we  can  testify  from  our  own 
experience;  for  we  keep  it  constantly  within  our 


LueiHOGiuBEtnunceiiez  r*  m  s     reach     and'   make   very   frequent    reference    to   it, 

^^^A^^?^h;?J™^  I  "early  always  finding  in  it  tl?e  information  we  seok! 


rendered  necessary  by  the  demands  of  the  public, 
affords  a  sufficient  evidence  of  the  general  apprecia 
tion  of  Dr.  Dnnglison's  labors  by  the  medical  pro 
fession  in  England  and  America.  It  is  a  book  which 
will  he  of  great  service  to  the  student,  in  teaching 
him  the  meaning  of  all  the  technical  terms  used  in 
medicine,  and  will  he  of  no  less  use  to  the  practi 
tioner  who  desires  to  keep  himself  on  a  level  with 
the  advance  of  medical  science. — London  Medical 
Times  and  Gazette. 

In  taking  leave  of  our  author,  we  feel  compelled 
to  confess  that  his  work  b> 

incredible  labor  havin,,  „„...„  ^^^^, ..  v.v.  „,,„„  lls>  ,„>,.„- 
position.  —  Edinburgh  Journal  of  Med.  Sciences. 
Sept.  Ib53. 

A  miracle  of  labor  and  industry  in  one  who  has 
written  able  and  voluminous  works  on  nearly  every 
branch  of  medical  science.  There  could  be  no  more 
useful  book  to  the  student  or  practitioner,  in  the 
present  advancing  age,  than  one  in  which  would  be 
found,  in  addition  to  the  ordinary  meaning  and  deri 
vation  of  medical  terms — so  many  of  which  are  of 
modern  introduction — concise  descriptions  of  their 

and  all  this  and  much     Harit    wjth  jhe  writins?s  of  the  ancient  and  modern 
Lime  before  us      It  is  I  «  masters  ()f  our  art)>>  reuders  him  skilful  to  note 


— British  and  Foreign  Med.-Chirurg.  Review. 

It  has  the  rare  merit  that  it  certainly  has  no  rival 
in  the  English  language  for  accuracy  and  extent 
of  references.  The  terms  generally  include  short 
physiological  and  pathological  descriptions,  so  that, 
as  the  author  justly  observes,  the  reader  does  not 
possess  in  this  work  a  mere  dictionary,  but  a  book. 
which,  while  it  instructs  him  in  medical  etymo 
logy,  furnishes  him  with  a  large  amount  of  useful 
information.  The  author's  labors  have  been  pro 
perly  appreciated  by  his  own  countrvmen  ;  and  we 
,vork  bears  evidence  of  almost  c;m  onlv  confirm  their  judgment,  by 'recommending 
"r  bTe.Cn  beS,t0^etLUC0n^lt?  C0m"  this  most  useful  volume  to  the  notice  of  our  cisat 
lantic  readers.  No  medical  library  will  be  complete 
without  it. — London  Med.  Gazette. 

It  is  certainly  more  complete  and  comprehensive 
than  any  with  which  we  are  acquainted  in  the 
English  language.  Few,  in  fact,  could  be  found 
better  qualified  than  Dr.  Dunglison  for  the  produc 
tion  of  such  a  work.  Learned,  industrious,  per 
severing,  and  accurate,  he  brings  to  the  task  all 
the  peculiar  talents  necessary  for  its  successful 
performance;  while,  at  the  same  time,  his  fami- 


3V,  and  tor  its  being  brought  i 
quite  up  to  the  date  of  publication  ;  the  author  states  :      One  °(  tlie  most  complete  and  copious  known  to 
in  his  preface  that  he  has  added  to  it  about  four  thou-  I  I'16   cultivators  of  medical   science.— Boston  Med. 


sand  terms,  which  are  not  to  he  found  in  the  prece 
ding  one.  — Dublin  Quarterly  Journal  of  Medical 
Sciences. 


Journal. 


The  most  comprehensive  and  best  English  Dic- 
..onary  of  medical  terms  extant. — Buffalo  Medical 
On   the  appearance   of  the   last   edition   of    this  |  Journal. 

BY   THE   SAME   AUTHOR. 

THE  PRACTICE  OF  MEDICINE.     A  Treatise  on  Special  Pathology  and  The 
rapeutics.     Third  Edition.     In  two  largo  octavo  volumes,  of  fifteen  hundred  pages. 
Upon  every  topic  embraced  in  the  work  the  latest    ferings  of  the  race.— Boston  Medical  and  Surgical 

information  will    he   found   carefully  posted  up. —    Journal. 

Medical  Examiner. 
,r<        t    ,     .     f        ..   .  It  is  certainly  the  most  complete  treatiseof  which 

nZnnt   vnlnm        me(1i.cine  fw'»  find'  m  ^™e  tw°  '  we  have  any  knowledge.-  Western  Journal  of  Med  i- 

elegant  volumes,   a  mine  of  facts,  a   gathering   of:  ,.,•„,,„,,,/  ««««»« 

precepts  and  advice  from  the  world  of  experience,  !  g    J' 

that    will  nerve  him  with    courage,   and  faithfully  I      One  of  the   most  elaborate  treatises  of  the  kind 

direct  him  m  las  efforts  to  relieve  the  physical  suf-     we  have.— Southern  Med.  and  Surg.  Journal. 


AND    SCIENTIFIC    PUBLICATIONS. 


I 


DUNGUSON    (ROBLEY),    M.D., 

Professor  of  Institutes  of  Medicine  in  the  Jefferson  Medical  College,  Philadelphia. 

HUMAN    PHYSIOLOGY.     Seventh   edition.     Thoroughly  revised    arid  exterj- 

sively  modified  and  enlarged,  with  nearly  five  hundred  illustrations.     In  two  large  and  hand 
somely  printed  octavo  volumes,  containing  nearly  1450  pages. 
It  has  long  since  taken  rank  as  one  of  the  medi 
cal  classics  of  our  language.     To  say  that  it  is  by 
far  the  best  text-book  of  physiology  ever  published 
in  this  country,   is  but  echoing   the  general  testi 
mony  of  the  profession. — N.  Y.  Journal  of  Medicine. 


There  is  no  single  book  we  would  recommend  to 
the  student  or  physician,  with  greater  confidence 
than  the  present,  because  in  it  will  be  found  a  mir 
ror  of  almost  every  standard  physiological  work  of 
the  day.  We  most  cordially  recommend  the  work 
to  every  member  of  the  profession,  and  no  student 
should  be  without  it.  It  is  the  completes!  work  on 


Physiology  in  the  English  language,  and  is  highly 
creditable  to  the  author  and  publishers. — Canadian 
Medical  Journal. 


The  most  complete  and  satisfactory  system  of 
Physiology  in  the  English  language. — Amer.  Mud. 
Journal. 

The  best  work  of  the  kind  in  the  English  lan 
guage. — Silliman's  Journal. 

The  most  full  and  complete  system  of  Physiology 
in  our  language. —  Western  Lancet. 


BY    THE    SAME    AUTHOR.       (JllSt  Issued.) 

GENERAL    THERAPEUTICS    AND    MATERIA  MEDIC  A;    adapted  for  a 

Medical  Text-book.     Fifth  edition,  much  improved.     With  one  hundred  and  eighty-seven  illus 

trations.     Iu  two  large  and  handsomely  printed  octavo  vols.,  of  about  1100  pages. 

The  new  editions  of  the  United  States  Pharmacopoeia  and  those  of  London  and  Dublin,  have  ren 

dered  necessary  a  thorough  revision  of  this  work.     In  accomplishing  this  the  author  has  spared  no 

pains  in  rendering  it  a  complete  exponent  of  all  that  is  new  and  reliable,  both  in  the  departments 

of  Therapeutics  and  Materia  Medica.     The  book  has  thus  been  somewhat  enlarged,  and  a  like  im 

provement  will  be  found  in  every  department  of  its  mechanical  execution.     As  a  convenient  text 

book  for  the  student,  therefore,  containing  within  a  moderate  compass  a  satisfactory  resume  of  ite 

important  subject,  it  is  again  presented  as  even  more  worthy  than  heretofore  of  the  very  great  favor 

which  it  has  received. 


In  this  work  of  Dr.  Dunglison,  we  recognize  the 
same  untiring  industry  in  the  collection  and  em 
bodying  of  facts  on  the  several  subjects  of  which  he 
treats,  that  has  heretofore  distinguished  him,  and 
we  cheerfully  point  to  these  volumes,  as  two  of  the 
most  interesting  that  we  know  of.  In  noticing  the 
additions  to  this,  the  fourth  edition,  there  is  very 
little  in  the  periodical  or  annual  literature  of  the 
profession,  published  in  the  interval  which  has 
elapsed  since  the  issue  of  the  first,  that  has  escaped 


As  a  text-book  for  students,  for  whom  it  is  par 
ticularly  designed,  we  know  of  none  superior  to 
it.  —  St.  Louis  Medical  and  Surgical  Journal. 

It  purports  to  be  a  new  edition,  but  it  is  rather 
a  new  book,  so  greatly  has  it  been  improved,  both 
in  the  amount  and  quality  of  the  matter  which  k 
contains.  —  N.  O.  Medical  and  Surgical  Journal. 

We  bespeak  for  this  edition,  from  the  profession, 


the  careful   search  of  the  author.     As 

reference,  it  is  invaluable.  —  Charleston  Med.  Jour 

nal  and  Review. 

It  may  be  said  to  be  the  work  now  upon  the  sub 
jects  upon  which  it  treats.  —  Western  Lancet. 


its    increased  merit.  —  IV.   Y. 


book  for  '  an  increase   of  patronage   over  any   of  its    former 
ones,  on   account  of 
Journal  of  Medicine. 

We  consider  this  work  unequalled. — Boston  Med  . 
and  Surg.  Journal. 


BY   THE   SAME    AUTHOR. 


NEW  REMEDIES,  WITH  FORMULAE  FOR  THEIR  ADMINISTRATION. 

Sixth  edition,  with  extensive  Additions.     In  one  very  large  octavo  volume,  of  over  750  pages. 
One  of  the  most  useful  of  the  author's  works. —    diseases  and  for  remedies,  will  be  found  greatly  to 
Southern  Medical  and  Surgical  Journal.  enhance  its  value. — New  York  Med.  Gazette. 


This  well-known  and  standard  book  has  now 
reached  its  sixth  edition,  and  has  been  enlarged  and 
improved  by  the  introduction  of  all  the  recent  gifts 
to  therapeutics  which  the  last  few  years  have  so 
richly  produced,  including  the  anaesthetic  agents, 
&c.  This  elaborate  and  useful  volume  should  be 
found  in  every  medical  library,  for  as  a  book  of  re 
ference,  for  physicians,  it  is  unsurpassed  by  any 
other  work  in  existence,  and  the  double  index  for 


The  great  learning  of  the  author,  and  his  remark 
able  industry  in  pushing  his  researches  into  every 
snurce  whence  information  is  derivable,  has  enabled 
him  to  throw  together  an  extensive  mass  of  facts 
and  statements,  accompanied  by  full  reference  to 
authorities;  which  last  feature  renders  the  work 
practically  valuable  to  investigators  who  desire  to 
examine  the  original  papers. — The  American  Journal 
of  Pharmacy. 


DURLACHER    (LEWIS). 
A   TREATISE    ON   CORNS,   BUNIONS,   THE    DISEASES    OF    NAILS, 

AND  THE  GENERAL   MANAGEMENT  OF   THE  FEET.    In  one  12mo.  volume,  cloth, 
pp.  134. 


DE  JONGH  (L.  J.),  M.  D.,  &c. 
THE  THREE  KINDS    OF  COD-LIVER  OIL,  comparatively  considered,  with 

their  Chemical  and  Therapeutic  Properties.  Translated,  with  an  Appendix  and  Cases,  by 
EDWARD  CAREY,  M.  D.  To  which  is  added  an  article  on  the  subject  from  "Dunglison  on  New 
Remedies."  In  one  small  12mo.  volume,  extra  cloth. 


DAY  (GEORGE  E.),  M.  D. 
A  PRACTICAL  TREATISE  ON  THE  DOMESTIC  MANAGEMENT  AND 

MORE  IMPORTANT  DISEASES  OF  ADVANCED  LIFE.  With  an  Appendix  on  a  new 
and  successful  mode  of  treating  Lumbago  and  other  forms  of  Chronic  Rheumatism.  One  volume , 
octavo,  220  pages. 


14 


BLANCHARD    <fe   LEA'S    MEDICAL 


ELLIS  (BENJAMIN),  M.D. 
THE    MEDICAL   FORMULARY :   being  a  Collection  of  Prescriptions,  derived 

from  the  writings  and  practice  of  many  of  the  most  eminent  physicians  of  America  and  Europe. 
Together  with  the  usual  Dietetic  Preparations  and  Antidotes  for  Poisons.  To  which  is  added 
an  Appendix,  on  the  Endermic  use  of  Medicines,  and  on  the  use  of  Ether  and  Chloroform.  The 
whole  accompanied  with  a  few  brief  Pharmaceutic  and  Medical  Observations.  Tenth  edition, 
revised  and  much  extended  by  ROBERT  P.  THOMAS,  M.  D.,  Professor  of  Materia  Medica  in  the 
Philadelphia  College  of  Pharmacy.  In  one  neat  octavo  volume,  of  two  hundred  and  ninety-six 
pages.  (Now  Ready.  Revised  and  enlarged  to  1854.) 

After  an  examination  of  the  new  matter  and  the        It  will  prove  particularly  useful  to  students  and 
alterations,  we  believe  the  reputation  of  the  work     young  practitioners,  as  the  most  important  prescrip- 
built  up  by  the  author,  and  the  late  distinguished     tions  employed  in  modern  practice,  which  He  scat- 
editor,  will  continue  to  flourish  under  the  auspices     tered  through  our  medical  literature,  are  here  col- 
of  the  present  editor,  who  has  the  industry  nnd  accu-     lected   and  conveniently  arranged   for   reference. — 
racy,  and,  we  would  say,  conscientiousness  requi-     Charleston  Med.  Journal  and  Review. 
site  for  the  responsible  task. — American  Journal  of 
Pharmacy,  March,  185L 


ERFCHSEN    (JOHN), 
Professor  of  Surgery  in  University  College,  London,  <kc. 

THE  SCIENCE  AND  ART  OF  SURGERY;  BEING  A  TREATISE  ON  SURGICAL 

INJURIES,  DISEASES,  AND  OPKRATIONS.  Edited  by  JOHN  H.  BRINTON,  M.  D.  Illustrated  with 
three  hundred  and  eleven  engravings  on  wood.  In  one  large  and  handsome  octavo  volume,  oJ 
over  nine  hundred  closely  printed  pages.  (Now  Ready.} 

This  is  a  new  work,  brought  up  to  May,  1854. 


It  is,  in  our  humble  judgment,  decidedly  the  best 
hook  of  the  kind  in  the  English  language.  Strange 
thai  just  such  books  are  noioftener  produced  by  pub 
lic  teachers  of  surgery  in  this  country  and  Great 
Britain  Indeed,  it  is  a  matter  of  great  astonishment, 
but  no  less  true  than  astonishing,  that  of  the  many 
works  on  surgery  repuhlished  in  ihis  country  within 
the  last  fifteen  or  twenty  years  as  text-books  for 
medical  student.*,  this  is  the  only  one,  that  even  ap 
proximates  to  the  fulfilment  of  the  peculiar  wants  of 
young  men  just  entering  upon  the  study  of  this  branch 
of  the  profession. —  Western  Jour,  of  Med.  and  Surgery. 

Embracing,  33  will  be  perceived,  the  whole 


,,v..  t,v,i .. ..,  ...u  ...  "•*!          rroi.  I'jricnseirs  wor«,  for  ns  si 

cal  domain,  and  each  division  of  itself  almost  com-     ,,urpassei| ;  his  nine   hundred  and  , 
plete  and  perfect,  each  chapter  full  ami  explicit,  each     fuse)y  j]|Uflra,ed,  are  rich  in  physii 


-subject  faithfully  exhibited,  we  can  only  express  our 
exumate  of  it  in  the  aggregate.  We  consider  it  an 
excellent  contribution  to  surgery,  as  probably  the 
best  single  volume  now  extant  on  the  subject  and 
with  grrjit  pleasure  we  add  it  to  our  textbooks  — 
Nashville  Journal  of  Medicine  and  Surgery. 


Its  value  is  greatly  enhanced  by  a  very  copious 
well-arranged  index.  We  regard  this  as  one  of  the 
most  valuable  contributions  to  mortem  surgery.  To 
one  entering  his  novitiate  of  practice,  we  regard  it 
the  most  serviceable  guide  which  he  can  consult.  He 
will  find  a  fulness  of  detail  leading  him  through  every 
step  of  the  operation,  and  not  deserting  him  until  the 
final  issue  of  the  case  is  decided.  For  the  same  rea 
son  we  recommend  it  to  those  whose  routine  of  prac 
tice  lies  in  such  parts  of  the  country  that  they  must 
rarely  encounter  cases  requiring"  surgical  manage 
ment. — Stethoscope. 

Prof.  Erichsen's  work,  for  its  size,  has  not  been 
eight  pages,  pro- 


)y  illustrated,  are  rich  in  physiological,  patholo 
gical.  a?)d  operative  suggestions,  doctrines,  details, 
and  processes;  and  will  prove  a  reliable  resource 
for  information,  both  to  physician  and  surgeon,  in  ttie 
hour  of  peril.—  N.  0.  Med.  and  Surg.  Journal. 


FOWNES  (GEORGE),  PH.  D.,  &c. 
ELEMENTARY    CHEMISTRY;    Theoretical  and  Practical.     With  numerous 

illustrations.  A  new  American,  from  the  last  and  revised  London  edition.  Edited,  with  Addi 
tions,  by  ROBERT  BRIDGES,  M.  D.  In  one  large  royal  12mo.  volume,  of  over  550  pages,  with  181 
wood-cuts,  sheep,  or  extra  cloth.  (Now  Ready.) 

The  lamented  death  of  the  author  has  caused  the  revision  of  this  edition  to  pass  into  the  hands  oi 
ihose  distinguished  chemists,  H.  Bence  Jones  and  A.  W.  Hofmann,  who  have  fully  sustained  its 
reputation  by  the  additions  which  they  have  made,  more  especially  in  the  portion  devoted  to  Organic 
Chemistry,  considerably  increasing  the  size  of  the  volume.  This  labor  has  been  so  thoroughly 
performed,  that  the  American  Editor  has  found  but  little  to  add,  his  notes  consisting  chiefly  of  such 
matters  as  the  rapid  advance  of  the  science  has  rendered  necessary,  or  of  investigations  which  had 
apparently  been  overlooked  by  the  author's  friends. 

The  volume  is  therefore  again  presented  as  an  exponent  of  the  most  advanced  state  of  chemical 
science,  and  as  not  unworthy  a  continuation  of  the  marked  favor  which  it  has  received  as  an  ele 
mentary  text-book. 

We  know  of  no  better  text-book,  especially  in  the  \      The  work  of  Dr.   Fowues  has  long  been  before 

the  public,  and  its  merits  have  been  fully  appreci 
ated  as  the  best  text-book  on  chemistry  now  in 
existence.  We  do  not,  of  course,  place  it  in  a  rank 
superior  to  the  works  of  Brande,  Graham,  Turner, 
Gregory,  or  Gmelin,  but  we  say  that,  as  a  work 
for  students,  it  is  preferable  to  any  of  them. — Lon 
don  Journal  of  Medicine. 

A  work  well  adapted  to  the  wants  of  the  student. 
It  is  an  excellent  exposition  of  the  chief  doctrines 
and  facts  of  modern  chemistry.  The  size  of  the  work, 
and  still  more  the  condensed  yet  perspicuous  style 
in  which  it  is  written,  absolve  it  from  the  charges 
very  properly  urged  against  most  manuals  termed 
popular. — Edinburgh  Monthly  Journal  of  Medical 
Science. 


difficult  department  of  organic  chemistry,  upon 
which  it  is  particularly  full  and  satisfactory.  We 
would  recommend  it  to  preceptors  as  a  capital 
"  office  book"  for  their  students  who  are  beginners 
in  Chemistry.  It  is  copiously  illustrated  with  ex 
cellent  wood-cuts,  and  altogether  admirably  "got 
up."—  Ar.  J.  Medical  Reporter,  March,  1854. 

A  standard  manual,  which  has  long  enjoyed  the 
reputation  of  embodying  much  knowledge  in  a  small 
space.  The  author  hasachieved  the  difficult  task  of 
condensation  \vith  masterly  tact.  His  book  is  con 
cise  without  being  dry,  and  brief  without  being  too 
dogmatical  or  general.—  Virginia  Med.  and  Surgical 
Journal . 


FRICK  (CHARLES),  M.  D. 
RENAL    AFFECTIONS;    their   Diagnosis  and  Pathology. 

One  volume,  royal  12mo.,  extra  cloth. 


With  illustrations. 


AND    SCIENTIFIC    PUBLICATIONS. 


15 


FERGUSSON   (WILLIAM),  F.  R.  S., 

Professor  of  Surgery  in  King's   College,  London,  &c. 

A  SYSTEM  OF  PRACTICAL  SURGERY.     Fourth  American,  from  the  third 

and  enlarged  London  edition.     In  one  large  and  beautifully  printed  octavo  volume,  of  about  seven 
hundred  pages,  with  three  hundred  and  ninety-three  handsome  illustrations.     (Just  Issued.) 


The  most  important  subjects  in  connection  with 
practical  surgery  which  have  been  more  recently 
brought  under  the  notice  of,  and  discussed  by,  the 
surgeons  of  Great  Britain,  are  fully  and  dispassion 
ately  considered  by  Mr.  Fergusson,  and  that  which 
was  before  wanting  has  now  been  supplied,  so  that 
we  can  now  look  upon  it  as  a  work  on  practical  sur 
gery  instead  of  one  on  operative  surgery  alone. 
There  was  some  ground  formerly  for  the  complaint 
before  alluded  to,  that  it  dwelt  too  exclusively  on 
operative  surgery  ;  but  this  defect  is  now  removed, 
and  the  book  is  more  than  ever  adapted  for  the  pur 
poses  of  the  practitioner,  whether  he  confines  him 
self  more  strictly  to  the  operative  department,  or 
follows  surgery  on  a  more  comprehensive  scale. — 
Medical  Times  and  Gazette. 


No  work  was  ever  written  which  more  nearly 
comprehended  the  necessities  of  the  student  and 
practitioner,  and  was  more  carefully  arranged  to 
that  single  purpose  than  this. — 2V.  Y.  Med.  and  Surg. 
Journal. 

The  addition  of  many  new  pages  makes  this  work 
more  than  ever  indispensable  to  the  student  and  prac 
titioner. — Ranking's  Abstract. 

Among  the  numerous  works  upon  surgery  pub 
lished  of  late  years,  we  know  of  none  we  value 
more  highly  than  the  one  before  us.  It  is  perhaps 
the  very  best  we  have  for  a  text-book  and  for  ordi 
nary  reference,  being  concise  and  eminently  practi 
cal. — Southern  Med.  and  Surg.  Journal. 


GRAHAM   (THOMAS),    F.  R.  S., 

Professor  of  Chemistry  in  University  College,  London,  &c. 

THE  ELEMENTS  OF  CHEMISTRY.     Including  the  application  of  the  Science 

to  the  Arts.     With  numerous  illustrations.     With  Notes  and  Additions,  by  ROBERT  BRIDGES, 
M.  D.,  &c.  &c.     Second  American,  from  the  second  and  enlarged  London  edition 
PART  I.  (Lately  Issued)  large  8vo.,  430  pages,  185  illustrations. 
PART  II.  (Preparing)  to  match. 

The  great  changes  which  the  science  of  chemistry  has  undergone  within  the  last  few  years,  ren 
der  a  new  edition  of  a  treatise  like  the  present,  almost  a  new  work.  The  author  has  devoted 
several  years  to  the  revision  of  his  treatise,  and  has  endeavored  to  embody  in  it  every  fact  and 
inference  of  importance  which  has  been  observed  and  recorded  by  the  great  body  of  chemics^ 
investigators  who  are  so  rapidly  changing  the  face  of  the  science.  In  this  manner  the  work  has 
been  greatly  increased  in  size,  and  the  number  of  illustrations  doubled  ;  while  the  labors  of  the  editor 
have  been  directed  towards  the  introduction  of  such  matters  as  have  escaped  the  attention  of  the 
author,  or  as  have  arisen  since  the  publication  of  the  first  portion  of  this  edition  in  London,  in  lS-r>0. 
Printed  in  handsome  style,  and  at  a  very  low  price,  it  is  therefore  confidently  presented  to  the  pro 
fession  and  the  student  as  a  very  complete  and  thorough  text-book  of  this  important  subject. 


GROSS  (SAMUEL  D.),   M.  D., 

Professor  of  Surgery  in  the  Louisville  Medical  Institute,  &c. 

A  PRACTICAL  TREATISE  ON  THE  DISEASES   AND  INJURIES   OF 

THE  URINARY  ORGANS.     In  one  large  and  beautifully  printed  octavo  volume,  of  over  seven 
hundred  pages.     With  numerous  illustrations. 


A  volume  replete  with  truths  and  principles  of  the 
utmost  value  in  the  investigation  of  these  diseases. — 
American  Medical  Journal. 

Dr.  Gross  has  brought  all  his  learning,  experi 
ence,  tact,  and  judgment  to  the  task,  and  has  pro 
duced  a  work  worthy  of  his  high  reputation.  We 
feel  perfectly  safe  in  recommending  it  to  our  read 
ers  as  a  monograph  unequalled  in  interest  and 


this  department  of  art.  We  have,  indeed,  unfeigned 
pleasure  in  congratulating  all  concerned  in  this  pub 
lication,  on  the  result  of  their  labours;  and  expe 
rience  a  feeling  something  like  what  animates  a  long- 
expectant  husband  man,  who,  often  times  disappointed 
by  the  produce  of  a  favorite  field,  is  at  last  agree 
ably  surprised  by  a  stately  crop  which  may  bear 
comparison  with  any  of  its  former  rivals.  The 


practical  value  bv  anv  other  on  the  subject  in  our  !  grounds  of  our  high  appreciation  of  the  work  will 
language.— Western  Journal  of  Med.  and  Surg.  be  obvious  as  we  proceed  ;  and  we  doubt  not  that. 

the  present  facilities  for  obtaining  American  books 
will  induce  many  of  our  readers  to  verify  our  re- 


It  has  remained  for  an  American  writer  to  wipe 


commendation  by  their  own  perusal  of  it. — British 
id  Foreign  Medico-Ckirurgical  Revieiv. 

Whoever  will  peruse  the  vast  amount  of  valuable 


away  this  reproach  ;  and  so  completely  has  the  task 

been  fulfilled,   that  we  venture  to  .predict  for  Dr.  j  and  Forei  gn  Medieo-Ckirurgical  Review. 

Gross's  treatise  a  permanent  place  in  the  literature  ' 

(vf  surgery,  worthy  to  rank  with  the  best  works  of 

the  present  age.     Not  merely  is  the  matter  good,  !  practical   information  it  contains,   and   which   we 

but  the  getting  up  of  the  volume  is  most  creditable  ]  have  been  unable  even  to  notice,  will,  we  think, 

to   transatlantic  enterprise;    the    paper  and   print  I  agree  with  us,  that  there  is  no  work  in  the  English 

would  do  credit  to  a  first-rate  London  establishment;     language  which  can  make  any  just  pretensions  to 

and  the  numerous  wood-cuts  which  illustrate  it,  de-    be  its  equal. — N.  Y.  Journal  of  Medicine. 

monstrate  that  America  is  making  rapid  advances  in  i 

BY  THE  SAME  AUTHOR.      (Now  Ready.) 

A  PRACTICAL  TREATISE  ON  FOREIGN  BODIES  IN  THE  AIR-PAS- 

SAGES.     In  one  handsome  octavo  volume,  with  illustrations. 

No  complete  monograph  on  this  interesting  and  difficult  subject  has  hitherto  appeared  in  any  lan 
guage.  The  profession  will  therefore  find  a  want  supplied  by  the  present  volume,  containing  an 
elaborate  investigation  of  the  nature,  symptoms,  and  treatment  of  this  class  of  accidents,  founded 
on  the  details  of  more  than  two  hundred  cases,  carefully  analyzed  and  compared.  .Besides  the  ex 
perience  gathered  from  the  author's  practice,  and  that  of  numerous  friends  and  correspondents,  he 
has  laboriously  collected  all  the  scattered  information  embodied  in  medical  periodicals,  reports  of 
learned  societies,  and  other  sources;  and,  examining  the  whole  by  the  aid  of  the  most  recent  patho 
logical  and  anatomical  investigations,  he  has  presented  a  complete  and  systematic  view  of  the  sub 
ject  in  all  its  bearings. 

BY  THE  SAME  AUTHOR.     (Preparing.) 

A  SYSTEM  OF  SURGERY ;  Diagnostic,  Pathological,  Therapeutic,  and  Opera- 

live.     With  very  numerous  engravings  on  wood. 


16  BLAN  CHARD    &    LEA'S    MEDICAL 

GRIFFITH   (ROBERT   E.),   M .  D.,  &c. 

A  UNIVERSAL  FORMULARY,  containing  the  methods  of  Preparing  and  Ad 
ministering  Officinal  and  other  Medicines.  The  whole  adapted  to  Physicians  and  Pharmaceu 
tists.  SECOND  EDITION,  thoroughly  revised,  with  numerous  additions,  by  ROBERT  P.  THOMAS, 
M.  D.,  Professor  of  Materia  Mcdica  in  the  Philadelphia  College  of  Pharmacy.  In  one  large  and 
handsome  octavo  volume,  of  over  six  hundred  pages,  double  columns.  (Just  Issued.) 
It  was  a  work  requiring  much  perseverance,  and  '  It  is  one  of  the  most  »sef  il  books  a  country  practi- 

when  published  was  looked  upon  as  by  far  the  best  |  tioner  can  possibly  have  in  his  possession. — Mtdicnl 

work  of  its  kind  that  had  issued  from  the  American     Chronicle. 

press  being  free  of  much  of  the  trashy,  and  embrac-  ,      The  amount  of  useful,  every-day  matter,  for  a  prac- 
most  of  the  non-officinal  formula  used  or  known  \  licinjr  physician,   is   really  immense.— Boston  Mtd. 


cm: 


in  American,  English,  or  French  practice,  arranged 
under  the  heads  of  the  several  constituent  drugs,  plac 
ing  the  receipt  under  its  more  important  constituent. 
Prof  Thomas  has  certainly  "improved."  as  well  as 
added  o  this  Formulary,  and  has  rendered  it  addition 
ally  deserving  of  the  confidence  of  pharmaceutists 
and  physicians. — American  Journal  of  Pharmacy. 

We  are  happy  to  announce  a  new  and  improved 
edition  of  this,  one  of  the  most  valuable  and  useful 
works  that  have  emanated  from  an  American  pen. 
It  would  do  credit  to  any  country,  and  will  be  found 
of  daily  usefulness  to  practitioners  of  medicine;  it  is 
better  adapted  to  their  purposes  than  the  dispensato 
ries.—  Southern  Med.  and  Surg.  Journal. 

A  new  edition  of  this  well-known  work,  edited  by 
R.  P.  Thomas,  M.  D.,  affords  occasion  for  renewing 
our  commendation  of  so  useful  a  handbook,  which 
ought  to  be  universally  studied  by  medical  men  of 

every  class,  ami  made  use  of  by  way  of  reference  by  j  effort  has  been  spared  to  include  in  them  all  tht 
office  pupils,  as  a  standard  authority.  It  has  been  j  rent  improvements  which  have  been  published  in 
much  enlarged,  and  now  condenses  a  vast  amount  j  medical  journals,  and  systematic  treatises.  A  work 
of  needful  and  necessary  knowledge  in  small  com-  j  of  this  kind  appears  to  us  indispensable  to  the  physi- 
pass.  The  more  of  such  books  the  better  for  the  pro-  cian,  and  there  is  none  we  can  more  cordially  recom- 
ftssion  and  the  public.—  N.  Y.  Med.  Gazette.  j  mend. — N.  Y.  Journal  of  Medicine. 

BY    THE    SAME    AUTHOR. 

BOTANY;  or,  a  Description  of  all  the  more  important  Plants  used 

in  Medicine,  and  of  their  Properties,  Uses,  and  Modes  of  Administration.     In  one  large  octavo 
volume,  of  704  pages,  handsomely  printed,  with  nearly  350  illustrations  on  wood. 


and  Surg.  Journal. 
This  is  a  work  of  six  hundred  and  fifty  one  pages, 
unbracing  all  on  the  subject  of  preparing  and  admi 
nistering  medicines  that  can  be  desired  by  the  physi 
cian  and  pharmaceutist. —  Western  Lancet. 

In  short,  it  is  a  full  and  complete  work  of  the  kind, 
and  should  be  in  the  hands  of  every  physician  and 
apothecary.— O.  Med.  and  Surg.  Journal 

We  predict  a  great  sale  for  this  work,  and  we  espe- 
ciallv  recommend  it  to  all  medical  teachers. — Iliek- 
mond  Stethoscope. 

This  edition  of  Dr.  Griffith's  work  has  been  greatly 
improved  by  the  revision  and  ample  additions  of  Dr. 
Thomas,  and  is  now,  wo  believe,  one  of  the  most 
complete  works  of  its  kind  in  any  lai'guage.  The 
additions  amount  to  about  seventy  pages,  and  no 


GLUGE  (GOTTLIEB),   M.  D., 

Professor  of  Physiology  and  Pathological  Anatomy  in  the  University  of  Brussels,  &c. 

AN  ATLAS   OF   PATHOLOGICAL   HISTOLOGY.     Translated,  with  Notes 

and  Additions,  by  JOSEPH  LEIDY,  M.  D.,  Professor  of  Anatomy  in  the  University  of  Pennsylva 
nia.  In  one  volume,  very  large  imperial  quarto,  with  three  hundred  and  twenty  figures,  plain 
and  colored,  on  twelve  copperplates. 


This  being,  as  far  as  we  know,  the  only  work  in 
which  pathological  histology  is  separately  treated 
'-'"  in  a  comprehensive  manner,  it  will,  we  think,  for 


the  unconnected  observations  of  a  great  number  of 
authors.  The  development  of  the  morbid  tissues, 
and  the  formation  of  abnormal  products,  may  now 


this  reason,  be  of  infinite  service  to  those  who  desire     be   followed   and   studied   with   the  same  ease  and 
systematically,  and  who     satisfaction  as  the  best    arranged 
arranging  in   their  mind  |  siology. — American  Med.  Journal. 


to  investigate  the  subject  systematically,  and  who  j  satisfaction  as  the  best    arranged   system   of  phy- 
have  felt  the  difficulty  of  arranging  in   their  mind 


GREGORY  (WILLIAM),   F.  R.  S.  E., 

Professor  of  Chemistry  in  the  University  of  Edinburgh,  &c. 

LETTERS    TO  A  CANDID    INQUIRER    ON    ANIMAL    MAGNETISM. 

In  one  neat  volume,  royal  12mo.,  extra  cloth. 


GARDNER  (D.  PEREIRA),  M .  D. 
MEDICAL  CHEMISTRY,  for  the  use  of  Students  and  the  Profession:  being  a 

Manual  of  the  Science,  with  its  Applications  to  Toxicology,  Physiology,  Therapeutics,  Hygiene, 
&c.     In  one  handsome  royal  12mo.  volume,  with  illustrations. 

HASSE  (C.   E.),   M.  D. 

AN  ANATOMICAL  DESCRIPTION  OF  THE  DISEASES  OF  RESPIRA 
TION  AND  CIRCULATION.     Translated  and  Edited  by  SWAINE.     Iu  one  volume,  octavo. 

HARRISON  (JOHN),   M.D. 
AN    ESSAY   TOWARDS   A   CORRECT   THEORY  OF   THE  NERVOUS 

SYSTEM.     In  one  octavo  volume,  292  pages. 


HUNTER  (JOHN). 
TREATISE  ON   THE  VENEREAL  DISEASE.     With  copious  Additions,  by 

DR.  PH.  RICOKI),  Surgeon  to  the  Venereal  Hospital  of  Paris.     Edited,  with  additional  Notes,  by 
F.  J.  BUIUSTEAD,  M.  D.     In  one  octavo  volume,  with  plates.    (Now  Ready.)     E2T3  See  RICORD. 
ALSO,  HUNTER'S  COMPLETE  WORKS,  with  Memoir,  Notes,  &c.  &c.     In  four  neat  octavo 
volumes,  with  plates. 


AND    SCIENTIFIC    PUBLICATIONS.  17 

HUGHES    (H.    M.),  M.  D., 

Assistant  Physician  to  Guy's  Hospital,  &c. 

A  CLINICAL  INTRODUCTION   TO   THE   PRACTICE   OF  AUSCULTA- 

TION,  and  other  Modes  of  Physical  Diagnosis,  in  Diseases  of  the  Lungs  and  Heart.     Second 
American  from  the  Second  and  Improved  London  Edition.  In  one  royal  12mo.  vol.  (Now  Ready.) 
It  has  been  carefully  revised  throughout.     Some  small  portions  have  been  erased;  much  has 
been,  I  trust,  amended;  and  a  great  deal  of  new  matter  has  been  added;  so  that,  though  funda 
mentally  it  is  the  same  book,  it  is  in  many  respects  a  new  work. — Preface. 


HORNER  (WILLIAM   E.),   M.  D., 

Professor  of  Anatomy  in  the  University  of  Pennsylvania. 

SPECIAL    ANATOMY    AND    HISTOLOGY.     Eighth  edition.     Extensively 

revised  and  modified.     In  two  large  octavo  volumes,  of  more  than  one  thousand  pages,  hand 
somely  printed,  with  over  three  hundred  illustrations. 

This  work  has  enjoyed  a  thorough  and  laborious  revision  on  the  part  of  the  author,  with  the 
view  of  bringing  it  fully  up  to  the  existing  state  of  knowledge  on  the  subject  of  general  and  special 
anatomy.  To  adapt  it  more  perfectly  to  the  wants  of  the  student,  he  has  introduced  a  large  number 
of  additional  wood-engravings,  illustrative  of  the  objects  described,  while  the  publishers  have  en 
deavored  to  render  the  mechanical  execution  of  the  work  worthy  of  the  extended  reputation  which 
it  has  acquired.  The  demand  which  has  carried  it  to  an  EIGHTH  EDITION  is  a  sufficient  evi 
dence  of  the  value  of  the  work,  and  of  its  adaptation  to  the  wants  of  the  student  and  professional 
reader. 

HOBLYN  (RICHARD  D.),  A.  M. 
A  DICTIONARY  OF   THE   TERMS   USED   IN  MEDICINE   AND   THE 

COLLATERAL   SCIENCES.     Second  and  Improved  American  Edition.     Revised,  with  nu 
merous  Additions,  from  the  second  London  edition,  by  ISAAC  HAYS,  M.  D.,  &c.     In  one  large 
royal  12mo.  volume,  of  over  four  hundred  pages,  double  columns.     (Nearly  Ready.) 
In  passing  this  work  a  second  time  through  the  press,  the  editor  has  subjected  it  to  a  very  tho 
rough  revision,  making  such  additions  as  the  progress  of  science  has  rendered  desirable,  and  sup 
plying  any  omissions  that  may  have  previously  existed.     As  a  concise  and  convenient  Dictionary 
of  Medical  Terms,  at  an.  exceedingly  low  price,  it  will  therefore  be  found  of  great  value  to  the  stu 
dent  and  practitioner. 

HOPE  (J.),   M.  D.,  F.  R.  S.,  &c. 
A  TREATISE  ON  THE    DISEASES    OF    THE    HEART    AND   GREAT 

VESSELS.     Edited  by  PENNOCK.    In  one  volume,  octavo,  with  plates,  572  pages. 

JONES  (C.   HANDFIELD),  F.  R.  S.,  &   EDWARD   H.   SIEVEKING,   M.D., 

Assistant  Physicians  and  Lecturers  in  St.  Mary's  Hospital,  London. 

A  MANUAL  OF  PATHOLOGICAL   ANATOMY.     First  American  Edition, 

Revised.     With  three  hundred  and  ninety-seven  handsome  wood  engravings.     In  one  large  and 
beautiful  octavo  volume  of  nearly  seven  hundred  and  fifty  pages. 

In  a  work  like  the  present,  intended  as  a  text-book  for  the  student  of  pathology,  accurate  engrav 
ings  of  the  various  results  of  morbid  action  are  of  the  greatest  assistance.  The  American  pub 
lishers  have,  therefore,  considered  that  the  value  of  the  work  might  be  enhanced  by  increasing  the 
number  of  illustrations,  and,  with  this  object,  many  wood-cuts,  from  the  best  authorities,  have  been 
introduced,  increasing  the  number  from  one  hundred  and  sixty-seven,  in  the  London  Edition,  to 
three  hundred  and  ninety-seven  in  this.  The  selection  of  these  wood-cuts  has  been  made  by  a 
competent  member  of  the  profession,  who  has  supervised  the  progress  of  the  work  through  the 
press,  with  the  view  of  securing  an  accurate  reprint,  and  of  correcting  such  errors  as  had  escaped 
the  attention  of  the  authors. 

With  these  improvements,  the  volume  is  therefore  presented  in  the  hope  of  supplying  the  ac 
knowledged  want  of  a  work  which,  within  a  moderate  compass,  should  embody  a  condensed  and 
accurate  digest  of  the  present  state  of  pathological  science,  as  extended  by  recent  microscopical, 
chemical,  and  physiological  researches. 

A  comprehensive  English  work  on  pathological  i  to  existed,  and  Drs.  Jones  and  Sieveking  deserve 
anatomy  has  long  been  a.  desideratum  in  medical  j  great  credit  for  the  manner  in  which  they  have  per- 
literature.  The  progress  of  pathological  science  has  '  formed  their  task.  They  have  availed  themselves 
been  so  rapid,  and  the  contributions  of  pathologists  of  the  best  existing  sources  of  information,  and  they 
have  been  so  numerous,  that  the  learner  has  been  have  confirmed  or  contested  the  conclusions  of  pre- 
compelled  to  resort  to  various  books  in  different  Ian-  ceding  authors  by  observations  made  by  themselves, 
guages,  and  to  monographs  on  special  subjects,  in  ;  The  book  is  also  abundantly  illustrated  by  -well- 
order  to  become  acquainted  with  the  morbid  affec-  '<  executed  wood-engravings,  many  of  which  are 
tions  of  the  human  body.  The  present  work  fills  up  |  drawn  from  specimens  examined  by  the  authors. — 
in  a  great  measure  the  deficiency  which  has  hither-  j  Med.  Times  and  Gazette. 


JONES  (T.  WHARTON),   F.  R.  S.,  £c. 
THE   PRINCIPLES  AND   PRACTICE   OF    OPHTHALMIC    MEDICINE 

AND  SURGERY.    Edited  by  ISAAC  HAYS,  M.  D.,  &c.     In  one  very  neat  volume,  large  royal 
]2mo.,  of  5'29  pages,  with  four  plates,  plain  or  colored,  and  ninety-eight  wood-cuts. 


The  work  amply  sustains,  in  every  point  the  al 
ready  high  reputation  of  the  author  as  an  ophthalmic 
surgeon  as  well  as  a  physiologist  and  pathologist. 
The  book  is  evidently  the  result  of  much  labor  arid 
research,  and  has  be'en  written  with  the  greatest 
care  and  attention.  We  entertain  little  doubt  that 
this  book  will  become  what  its  author  hoped  it 


might  become,  a  manual  for  daily  reference  and 
consultation  by  the  student  and  the  general  practi 
tioner.  The  work  is  marked  by  that  correctness, 
clearness,  and  precision  of  style  which  distinguish 
all  the  productions  of  the  learned  author. — British 
and  Foreign  Medical  Review. 


IS 


BLANCHARD    &    LEA'S    MEDICAL 


KIRKES  (WILLIAM   SENHOUSE),    M.  D., 

Demonstrator  of  Morbid  Anatomy  at  St.  Bartholomew's  Hospital,  &c.;  and 

JAMES   PAGET,   F.  R.  S., 

Lecturer  on  General  Anatomy  and  Physiology  in  St.  Bartholomew's  Hospital. 

A    MANUAL    OF    PHYSIOLOGY.     Second  American,  from  the  second  and 

improved  London  edition.     With  one  hundred  and  sixty-five  illustrations.     In  one  large  and 
handsome  royal  12mo.  volume,     pp.550.     (Just  Issued.) 


In  the  present  edition,  the  Manual  of  Physiology 
has  been  brought  up  to  the  actual  condition  of  the 
science,  and  fully  sustains  the  reputation  which  it 
has  already  so  deservedly  attained.  We  consider 
the  work  of  MM.  Kirkes  and  Paget  to  constitute  one 
of  the  very  best  handbooks  of  Physiology  we  possess 
— presenting  just  such  an  outline  of  the  science,  com 
prising  an  account  of  its  leading  facts  and  generally 
admitted  principles,  as  the  student  requires  during 
his  attendance  upon  a  course  of  lectures,  or  for  re 
ference  whilst  preparing  for  examination.  The  text 
is  fully  and  ably  illustrated  by  a  series  of  very  supe 
rior  wood-engravings,  by  which  a  comprehension  of 
some  of  the  more  intricate  of  the  subjects  treated  of 
is  greatly  facilitated. — Am.  Medical  Journal, 

We  need  only  say,  that,  without  entering  into  dis 
cussions  of  unsettled  questions,  it  contains  all  the 
recent  improvements  in  this  department  of  medical 
science.  For  the  student  beginning  this  study,  and 
the  practitioner  who  has  but  leisure  to  refresh  his 
memory,  this  book  is  invaluable,  as  it  contains  all 


that  it  is  important  to  know,  without  special  details, 
which  are  read  with  interest  only  by  those  who 
would  make  a  specialty,  or  desire  to  possess  a  criti 
cal  knowledge  of  the  subject. — Charleston  Medical 
Journal. 

One  of  the  best  treatises  that  can  be  put  into  the 
hands  of  the  student. — London  Medical  Gazette. 

The  general  favor  with  which  the  first  edition  of 
this  work  was  received,  and  its  adoption  as  a  favor 
ite  text-book  by  many  of  our  colleges,  will  insure  a 
large  circulation  to  this  improved  edition.  It  will 
fully  meet  the  wants  of  the  student.  —  Southern 
Med.  and  Surg.  Journal. 

Particularly  adapted  to  those  who  desire  to  pos 
sess  a  concise  digest  of  the  facts  of  Human  Physi 
ology. — British  and  Foreign  Med.-Chirurg.  Review. 

We  conscientiously  recommend  it  as  an  admira 
ble  "  Handbook  of  Physiology." — London  Journal 
of  Medicine. 


KNAPP  (F.),  PH.  D.,  &c. 

TECHNOLOGY ;  or,  Chemistry  applied  to  the  Arts  and  to  Manufactures.  Edited, 
with  numerous  Notes  and  Additions,  by  Dr.  EDMUND  RONALDS  and  Dr.  THOMAS  KICHARDSON. 
First  American  edition,  with  Notes  and  Additions,  by  Prof.  WALTER  K.  JOHNSON.  In  two  hand 
some  octavo  volumes,  printed  and  illustrated  in  the  highest  style  of  art,  with  about  five  hundred 
wood-engravings. 


PHYSIOLOGICAL 

(Preparing.) 


LEHMANN. 
CHEMISTRY.      Translated  by  GEORGE  E.  DAY,  M.  D. 


LEE  (ROBERT),   M.  D.,  F.  R.  S.,  &c. 
CLINICAL    MIDWIFERY;    comprising  the    Histories  of  Five  Hundred  and 

Forty-five  Cases  of  Difficult,  Preternatural,  and  Complicated  Labor,  with  Commentaries.    From 
the  second  London  edition.     In  one  royal  12mo.  volume,  extra  cloth,  of  238  pages. 


LA    ROCHE   (R.),    M.  D.,  &c. 

PNEUMONIA ;  its  Supposed  Connection,  Pathological  and  Etiological,  with  Au 
tumnal  Fevers,  including  an  Inquiry  into  the  Existence  and  Morbid  Agency  of  Malaria.  In  one 
handsome  octavo  volume,  extra  cloth,  of  500  pages. 

A  more  simple,  clear,  and  forcible  exposition  of  |  the  periodical  press,  and  yet  in  the  work  before  us 
the  groundless  nature  and  dangerous  tendency  of  |  he  has  exhibited  an  amount  of  industry  and  learning-, 
certain  pathological  and  etiological  heresies,  has  I  research  and  ability,  beyond  what  we  are  accustomed 
seldom  been  presented  to  our  notice. — N.  Y.  Journal  \  to  discover  in  modern  medical  writers;  while  his 
of  Medicine  and  Collateral  Science,  March,  1854.  |  own  extensive  opportunities  for  observation  and 


This  work  should  be  carefully  studied  by  Southern 
physicians,  embodying  as  it  does  the  reflections  of 
an  original  thinker  and  close  observer  on  a  subject 
peculiarly  their  own. — Virginia  Med.  and  Surgical 
Journal. 

The  author  had  prepared  us  to  expect  a  treatise 


|  experience  have  been  improved  by  the  most  laudable 
diligence,  and  display  a  familiarity  with  the  whole 
subject  in  every  aspect,  which  commands  both  our 
respect  and  confidence.  As  a  corrective  of  prevalent 
and  mischievous  error,  sought  to  be  propagated  by 
novices  and  innovators,  we  could  wish  that  Dr.  La 
Roche's  book  could  be  widely  read. — N.  Y.  Medical 


from  him,  by  his  brief  papers  on  kindred  topics  in  1  Gazette. 

BY  THE  SAME  AUTHOR.      (Ll  Press.) 

YELLOW  FEVER,  considered   in  its  Historical,  Pathological,  and   Etiological 

Relations.     In  one  very  large  and  handsome  octavo  volume. 


LONGET   (F.  A.) 

TREATISE  ON  PHYSIOLOGY.  With  numerous  Illustrations.  Translated 
from  the  French  by  F.  G.  Smith,  M.  D.,  Professor  of  Institutes  of  Medicine  in  the  Pennsylvania 
Medical  College.  ' (Preparing.) 


AND    SCIENTIFIC    PUBLICATIONS.  19 

LAWRENCE  (W.)}   F.  R.  S.,  &c. 
A  TREATISE    ON    DISEASES    OF    THE    EYE.     A    new  edition,   edited, 

with  numerous  additions,  and  243  illustrations,  by  ISAAC  HAYS,  M.  D.,  Surgeon  to  Wills  Hospi 
tal,  &c.     In  one  very  large  and  handsome  octavo  volume,  of  950  pages,  strongly  bound  in  leather 
with  raised  bands.     (Now  Ready.) 
This  work  is  thoroughly  revised  and  brought  up  to  1854. 

This  work  is  so  universally  recognized  as  the  standard  authority  on  the  subject,  that  the  pub- 
Kshers  in  presenting  this  new  edition  have  only  to  remark  that  in  its  preparation  the  editor  has 
carefully  revised  every  portion,  introducing  additions  and  illustrations  wherever  the  ndvance  of 
science  has  rendered  them  necessary  or  desirable.  In  this  manner  it  will  be  found  to  con 
tain  over  one  hundred  pages  more  than  the  last  edition,  while  the  list  of  wood-engravings 
has  been  increased  by  sixty-seven  figures,  besides  numerous  improved  illustrations  substituted 
for  such  as  were  deemed  imperfect  or  unsatisfactory.  The  various  important  contributions  to 
o-phthalmological  science,  recently  made  by  Dalrymple,  Jacob,  Walton,  Wilde,  Cooper,  &c., 
both  in  the  form  of  separate  treatises  and  contributions  to  periodicals,  have  been  carefully 
examined  by  the  editor,  and,  combined  with  the  results  of  his  own  experience,  have  been 
freely  introduced  throughout  the  volume,  rendering  it  a  complete  and  thorough  exponent  of 
the  most  advanced  state  of  the  subject. 

In  a  future  number  we  shall  notice  more  at  length  |  octavo  pages—  has  enabled  both  author  and  editor  to 
this  admirable  treatise- the  safest  guide  and  most  '  do  justice  to  all  the  details  of  this  subject,  and  con- 
cornprehensive  work  of  reference,  which  is  within  dense  in  this  single  volume  the  present  state  of  our 
the  reach  of  all  classes  of  the  profession.— -Stetlio-  [  knowledge  of  the  whole  science  in  this  department, 
scope,  March,  1854.  j  whereby  its  practical  value  cannot  be  excelled.  We 

heartily  commend  it,  especially  as  a  book  of  refe- 

This  standard  text-book  on  the  department  of  !  rence,  indispensable  in  every  medical  library.  The 
which  it  treats,  has  not  been  superseded,  by  any  or  additions  of  the  American  editor  very  greatly  en- 
all  of  the  numerous  publications  on  the  subject  hance  the  value  of  the  work,  exhibiting  the  learning 
heretofore  issued.  Nor  with  the  multiplied  improve-  !  and  experience  of  Dr.  Hays,  in  the  light  in  which  he 
ments  of  Dr.  Hays,  the  American  editor,  is  it  at  all  ought  to  be  held,  as  a  standard  authority  on  all  sub- 
likely  that  this  great  work  will  cease  to  merit  the  ;  jects  appertaining  to  this  specialty,  to  which  he  has 
confidence  and  preference  of  students  or  practition-  rendered  so  many  valuable  contributions.— N.  Y. 
era.  Its  ample  extent — nearly  one  thousand  large  ,  Medical  Gazette. 

BY   THE   SAME   AUTHOR. 

A  TREATISE  ON  RUPTURES;  from  the  fifth  London  edition.  In  one  octavo 
volume,  sheep,  480  pages. 

LUDLOW    (J.    L.),    M.  D., 

Lecturer  on  Clinical  Medicine  at  the  Philadelphia  Almshouse,  &c. 

A  MANUAL  OF  EXAMINATIONS  upon  Anatomy  and  Physiology,  Surgery, 

Practice  of  Medicine,  Chemistry,  Obstetrics,  Materia  Medica,  Pharmacy,  and  Therapeutics. 
Designed  for  Students  of  Medicine  throughout  the  United  States.  A  new  edition,  revised  and 
extensively  improved.  In  one  large  royal  12mo.  volume,  with  several  hundred  illustrations. 
(Preparing.) 

LISTON  (ROBERT),   F.  R.  S.,  &c. 
LECTURES  ON  THE  OPERATIONS  OF  SURGERY,  and  on  Diseases  and 

Accidents  requiring  Operations.  Edited,  with  numerous  Additions  and  Alterations,  by  T.  D. 
MUTTER,  M.  D.  In  one  large  and  handsome  octavo  volume,  of  566  pages,  with  216  wood-cuts. 

LALLEMAND  (M.). 

THE  CAUSES,  SYMPTOMS,  AND  TREATMENT  OF  SPERMATOR 
RHOEA.  Translated  and  edited  by  HENRY  J.  McDouGAL.  In  one  volume,  octavo,  320  pages. 
Second  American  edition.  (Just  Issued.) 

LARDNER  (DIONYSIUS),   D.  C.  L.,  &c. 
HANDBOOKS    OF    NATURAL    PHILOSOPHY    AND    ASTRONOMY. 

Revised,  with  numerous  Additions,  by  the  American  editor.  FIRST  COURSE,  containing  Mecha 
nics,  Hydrostatics,  Hydraulics,  Pneumatics,  Sound,  and  Optics.  In  one  large  royal  12rno. 
volume,  of  750  pages,  with  424  wood-cuts.  SECOND  COURSE,  containing  Heat,  Electricity,  Mag 
netism,  and  Galvanism,  one  volume,  large  royal  12mo.,  of  450  pages,  with  250  illustrations. 
THIRD  COURSE  (  now  ready),  containing  Meteorology  and  Astronomy,  in  one  large  volume,  royal 
12mo.  of  nearly  eight  hundred  pages,  with  thirty-seven  plates  and  two  hundred  wood-cuts.  The 
whole  complete  in  three  volumes,  of  about  two  thousand  large  pages,  with  over  one  thousand 
figures  on  steel  and  wood. 

The  various  sciences  treated  in  this  work  will  be  found  brought  thoroughly  up  to  the  latest  period. 
The  work  furnishes  a  very  clear  and  satisfactory  |  factory^  manner  the  information  they  desire.— The 


account  of  our  knowledge  in  the  important  depart- 


it  depart 

ment  of  science  of  which  it  treats.     Although  the 
medical  schools  of  this  country  do  not  include  the 

study  of  physics  in  their  course  of  instruction,  yet    all  that  has  been  developed  in  relation  to  the  great 
no  student  or  practitioner  should  be  ignorant  of  its    forces  of  nature,  Heat,  Magnetism,  and  Electricity 


Virginia  Med.  and  Surg.  Journal. 
The  present  treatise  is  a  most  complete  digest  of 


laws.  Besides  being  of  constant  application  in  prac 
tice,  such  knowledge  is  of  inestimable  utility  in  fa 
cilitating  the  study  of  other  branches  of  science.  T( 


Their  laws  are  elucidated  in  a  manner  both  pleasing 
and  familiar,  and  at  the  same  time  perfectly  intelli 
gible  to  the  student.  The  illustrations  are  suffi- 


tudents,  then,  and  to  those  who.  having  already  en- |  ciently  numerous  and  appropriate,  and  altogether 


tered  upon  the  active  pursuits  of  business,  are  desir 
ous  to  sustain  and  improve  their  knowledge  of  the 
general  truths  of  natural  philosophy,  we  can  recom 
mend  this  work  as  supplying  in  a  clear  and  satis- 


we  can  cordially  recommend  the  work  as  well-de 
serving  the  notice  both  of  the  practising  physician 
and  the  student  of  medicine. — The  Med.  Examiner. 


This  book  will  add  more  to  his  fame  than  either 
of  those  which  bear  his  name.  Indeed  we  doubt 
whether  any  material  improvement  will  be  made  on 
the  teachings  of  this  volume  for  a  century  to  come, 
since  it  is  so  eminently  practical,  and  based  on  pro 
found  knowledge  of  the  science  and  consummate 
skill  in  the  art  of  healing,  and  ratified  by  an  ample 
and  extensive  experience,  such  as  few  men  have  the 
industry  or  good  fortune  to  acquire. — N.  Y.  Med. 
Gazette. 


20  BLANCHARD    &   LEA'S    MEDICAL 

MEIGS  (CHARLES   D.)f  M.  D., 

Professor  of  Obstetrics,  &c.  in  the  Jefferson  Medical  College,  Philadelphia. 

ON    THE    NATURE,     SIGNS,    AND    TREATMENT    OE    CHILDBED 

FEVER.     In  a  Series  of  Letters  addressed  to  the  Students  of  his  Class.     In  one  handsome 

octavo  volume,  of  three  hundred  and  sixty-five  pages.    (Now  Ready.) 

The  instructive  and  interesting  author  of  this 
work,  whose  previous  labors  in  the  department  of 
medicine  which  he  so  sedulously  cultivates,  have 
placed  his  countrymen  under  deep  and  abiding  obli 
gations,  again  challenges  their  admiration  in  the 
r'resh  and  vigorous,  attractive  and  racy  pages  before 
us.  It  is  a  delectable  book.  *  *  *  This  treatise 
upon  child-bed  fevers  will  have  an  extensive  sale, 
being  destined,  as  it  deserves,  to  find  a  place  in  the 
library  of  every  practitioner  who  scorns  to  lag  in  the 
rear  of  his  brethren. — Nashville  Journal  of  Medi 
cine  and  Surgery. 

BY   THE   SAME    AUTHOR. 

WOMAN :  HER  DISEASES  AND  THEIR  REMEDIES.  A  Series  of  Lec 
tures  to  his  Class.  Third  and  Improved  edition.  In  one  large  and  beautifully  printed  octavo 
volume.  (Just  Issued.  Revised  and  enlarged  to  1854.) 

The  gratifying  appreciation  of  his  labors,  as  evinced  by  the  exhaustion  of  two  large  impressions* 
ef  this  work  within  a  few  years,  has  not  been  lost  upon  the  author,  who  has  endeavored  in  every 
way  to  render  it  worthy  of  the  favor  with  which  it  has  been  received.  The  opportunity  thus 
afforded  for  a  second  revision  has  been  improved,  and  the  work  is  now  presented  as  in  every  way 
superior  to  its  predecessors,  additions  and  alterations  having  been  made  whenever  the  advance  of 
science  has  rendered  them  desirable.  The  typographical  execution  of  the  work  will  also  be  found 
to  have  undergone  a  similar  improvement  and  the  work  is  now  confidently  presented  as  in  every 
way  worthy  the  position  it  has  acquired  as  the  standard  American  text-book  on  the  Diseases  of 
Females. 

It  contains  a  vast  amount  of  practical  knowledge,  |  such  bold  relief,  as  to  produce  distinct  impressions 
by  one  who  has  accurately  observed  and  retained  upon  the  mind  and  memory  of  the  reader.  —  The 


the  experience  of  many  years,  and  who  tells  the  re 
sult  in  a  free,  familiar,  and  pleasant  manner. — Dub 
lin  Quarterly  Journal. 


Charleston  Med.  Journal. 

Professor  Meigs   has  enlarged  and  amended  this 
great  work,  for  such  it   unquestionably  is,  having 


There  is  an  off-hand  fervor,  a  glow,  and  a  warm-  i  passed  the  ordeal  of  criticism  at  home  and  abroad, 
heartedness  infecting  the  effort  of  Dr.  Meigs,  which  j  but  been  improved  thereby  ;  for  in  this  new  edition 
is  entirely  captivating,  and  which  absolutely  hur-  I  the  author  has  introduced  real  improvements,  and 
ries  the  reader  through  from  beginning  to  end.  Be-  j  increased  the  value  and  utility  of  the  book  im- 
sides,  the  book  teems  with  solid  instruction,  and  i  measurably.  It  presents  so  many  novel,  bright, 
it  shows  the  very  highest  evidence  of  ability,  viz.,  and  sparkling  thoughts;  such  an  exuberance  of  new 


the  clearness  with  which  the  information  is  pre 
sented.  We  know  of  no  better  test  of  one's  under 
standing  a  subject  than  the  evidence  of  the  power 


ideas  on  almost  every  page,  that  we  confess  our 
selves  to  have  become  enamored  with  the  book 
and  its  author  ;  and  cannot  withhold  our  congratu- 


of  lucidly  explaining  it.     The  most  elementary,  as  j  lations  from  our  Philadelphia  confreres,  that  such  a 
well  as  the  obscurest  subjects,  under  the  pencil  of  i  teacher  is  in  their  service. — N.  Y.  Med.  Gazette. 
Prof.  Meigs,  are  isolated  and  made  to  stand  out  in  | 

BY   THE   SAME   AUTHOR. 

OBSTETRICS :  THE  SCIENCE  AND   THE   ART.     Second  edition,  revised 

and  improved.     With  one  hundred  and  thirty-one  illustrations.     In  one  beautifully  printed  octavo 
volume,  of  seven  hundred  and  fifty-two  large  pages.     (Lately  Published.) 

The  rapid  demand  for  a  second  edition  of  this  work  is  a  sufficient  evidence  that  it  has  supplied 
a  desideratum  of  the  profession,  notwithstanding  the  numerous  treatises  on  the  same  subject  which 
have  appeared  within  the  last  few  years.  Adopting  a  system  of  his  own,  the  author  has  combined 
the  leading  principles  of  his  interesting  and  difficult  subject,  with  a  thorough  exposition  of  its  rules 
of  practice,  presenting  the  results  of  long  and  extensive  experience  and  of  familiar  acquaintance 
with  all  the  modern  writers  on  this  department  of  medicine.  As  an  American  Treatise  on  Mid 
wifery,  which  has  at  once  assumed  the  position  of  a  classic,  it  possesses  peculiar  claims  to  the  at 
tention  and  study  of  the  practitioner  and  student,  while  the  numerous  alterations  and  revisions 
which  it  has  undergone  in  the  present  edition  are  shown  by  the  great  enlargement  of  the  work, 
which  is  not  only  increased  as  to  the  size  of  the  page,  but  also  in  the  number. 

BY    THE   SAME    AUTHOR.      (Now  Ready.) 

A  TREATISE  ON  ACUTE  AND  CHRONIC  DISEASES  OF  THE  NECK 

OF  THE  UTERUS.     With  numerous  plates,  drawn  and  colored  from  nature  in  the  highest 
style  of  art.     In  one  handsome  octavo  volume,  extra  cloth. 

The  object  of  the  author  in  this  work  has  been  to  present  in  a  small  compass  the  practical  results 
of  his  long  experience  in  this  important  and  distressing  class  of  diseases.  The  great  changes  intro 
duced  into  practice,  and  the  accessions  to  our  knowledge  on  the  subject,  within  the  last  few  years, 
resulting  from  the  use  of  the  metroscope,  brings  within  the  ordinary  practice  of  every  physician 
numerous  cases  which  were  formerly  regarded  as  incurable,  and  renders  of  great  value  a  work  like 
the  present  combining  practical  directions  for  diagnosis  and  treatment  with  an  ample  series  of 'illus 
trations,  copied  accurately  from  colored  drawings  made  by  the  author,  after  nature. 

BY   THE   SAME   AUTHOR. 

OBSERVATIONS   ON    CERTAIN    OF    THE    DISEASES     OF    YOUNG 

CHILDREN.     In  one  handsome  octavo  volume,  of  214  pages. 


AND    SCIENTIFIC    PUBLICATIONS.  21 

MILLER  (JAMES),   F.  R.  S.  E., 

Professor  of  Surgery  in  the  University  of  Edinburgh,  &c. 

PRINCIPLES  OF  SURGERY.     Third  American,  from  the  second  and  revised 

Edinburgh  edition.  Revised,  with  Additions,  by  F.  W.  SARGENT,  M.  D.,  author  of  "  Minor  Sur 
gery,"  &c.  In  one  large  and  very  beautiful  volume,  of  seven  hundred  and  fifty-two  pages,  with 
two  hundred  and  forty  exquisite  illustrations  on  wood. 

This  edition  is  far  superior,  both  in  the  abundance  j  guage.  This  opinion,  deliberately  formed  after  a 
and  quality  of  its  material,  to  any  of  the  preceding,  careful  study  of  the  first  edition,  we  have  had  no 
We  hope  it  will  be  extensively  read,  and  the  sound  |  cause  to  change  on  examining  the  second.  This 


principles  which  are  herein  taught  treasured  up  for 
future  application.  The  work  takes  rank  with 
Watson's  Practice  of  Physic  ;  it  certainly  does  not 
fall  behind  that  great  work  in  soundness  of  princi 
ple  or  depth  of  reasoning  and  research.  No  physi 
cian .who  values  his  reputation,  or  seeks  the  interests 
of  his  clients,  can  acquit  himself  before  his  God  and 
the  world  without  making  himself  familiar  with  the 
sound  and  philosophical  views  developed  in  the  fore 
going  book. — New  Orleans  Med.  and  Surg.  Journal. 
Without  doubt  the  ablest  exposition  of  the  prin 
ciples  of  that  branch  of  the  healing  art  in  any  lan- 


edit.ion  has  undergone  thorough  revision  by  the 
thor;  many  expressions  have  been  modified,  and  a 
mass  of  new  matter  introduced.  The  book  is  got  up 
in  the  finest  style,  and  is  an  evidence  of  the  progress 
of  typography  in  our  country. — Charleston  Medical 
Journal  and  Review. 

We  recommend  it  to  both  student  and  practitioner, 
feeling  assured  that  as  it  now  comes  to  us,  it  pre 
sents  the  most  satisfactory  exposition  of  the  modern 
doctrines  of  the  principles  of  surgery  to  be  found  in 
any  volume  in  any  language. — N.  Y.  Journal  of 


Medicine. 
BY   THE   SAME   AUTHOR.      (NoiV  Ready.) 

THE  PRACTICE  OF  SURGERY.  Third  American  from  the  second  Edin 
burgh  edition.  Edited,  with  Additions,  by  F.  W.  SARGENT,  M.  D  ,  one  of  the  Surgeons  to  Will's 
Hospital,  fcc.  Illustrated  by  three  hundred  and  nineteen  engravings  on  wood.  In  one  large 
octavo  volume,  of  over  seven  hundred  pages. 

No  encomium  of  ours  could  add  to  the  popularity  j  By  the  almost  unanimous  voice  of  the  profession, 
of  Miller's  Surgery.  Its  reputation  in  this  country  j  his  works,  both  on  the  principles  and  practice  of 
is  unsurpassed  by  that  of  any  other  work,  and,  when  •  surgery  have  been  assigned  the  highest  rank.  If  we 
taken  in  connection  with  the  author's  Principles  of\  were  limited  to  but  one  work  on  surgery,  that  one 
Surgery,  constitutes  a  whole,  without  reference  to  j  should  be  Miller's,  as  we  regard  it  superior  to  all 
which  no  conscientious  surgeon  would  be  willing  •  others. — St.  Louis  Med.  and  Surg.  Journal. 
to  practice  his  art.  The  additions,  by  Dr.  Sargent,  ' 

have  materially  enhanced  the  value  of  the  work.-  I      Tlie  "utllor  distinguished  alike  as  a  practitioner 
Southern  Medical  and  Surgical  Journal.  »nd  writer,  has  m  this  and  his  "  Principles,1'  pre- 

.    .       .,  sen  ted  to  the  profession  one  of  the  moat  complete  and 

It  is  seldom  that  two  volumes  have  ever  made  so  |  reiial)le  systems  of  Surgery  extant.  His  st.vle  of 
profound  an  impression  in  so  short  a  time  as  the  j  wririn?  is  original,  impressive,  and  engaging,  ener- 
•  Principles"  and  the  "  Practice"  of  Surgery  by  j  tic  concise,  and'lucid.  Few  have  the  faculty  of 
Mr.  Miller— or  so  richly  merited  the  reputation  they  j  Condensing  so'much  in  small  space,  and  at  the  same 
have  acquired.  The  author  is  an  eminently  sensi-  \  tjme  so  persistently  holding  the  attention;  indeed, 
ble,  practical,  and  well-informed  man,  who  knows  j  he  appears  to  make  the  very  process  of  condensation 
exactly  what  he  is  talking  about,  and  exactly  how  to  a  me;ms  of  eliminating  attractions.  Whether  as  a 


talk  it.— Kentucky  Medical  Recorder. 


mating 
text-book  for  students  or   a   book  of  reference  for 


The  two  volumes  together  form  a  complete  expose     practitioners,  it  cannot  be  too  strongly  recommend- 
of  the  present  state  of  Surgery,  and  they  ought  to  be  :  ed. — Southern  Journal  of  the  Medical  and  Physical 
on  the  shelves  of  every  surgeon. — N.  J.  Med.  Re-  j  Sciences, 
porter. 


MALGAIGNE  (J.  F.). 

OPERATIVE  SURGERY,  based  on  Normal  and  Pathological  Anatomy.     Trans 
lated  from  the  French,  by  FREDERICK  BRITTAN,  A.  B.,  M.  D.    With  numerous  illustrations  on 
wood.     In  one  handsome  octavo  volume,  of  nearly  six  hundred  pages. 
We  unhesitatingly  pronounce   it  the   very   best  1  profession  in  any  language. — Charleston  Med.  and 

guide  in  surgical  operations  that  has  come  before  the  |  Surg.  Journal. 

MOHR  (FRANCIS),  PH.  D.,  AND  REDWOOD  (TH  EOPH  I  LUS). 
PRACTICAL    PHARMACY.     Comprising  the  Arrangements,  Apparatus,  and 

Manipulations  of  the  Pharmaceutical  Shop  and  Laboratory.  Edited,  with  extensive  Additions, 
by  Prof.  WILLIAM  PROCTER,  of  the  Philadelphia  College  of  Pharmacy.  In  one  handsomely 
printed  octavo  volume,  of  570  pages,  with  over  500  engravings  on  wood. 

It  is  a  book,  however,  which  will  be  in  the  hands  '  sary  thereto.  On  these  matters,  this  work  is  very 
of  almost  every  one  who  is  much  interested  in  phar-  [full  and  complete,  and  details,  in  a  style  uncom- 
maceutical  operations,  as  we  know  of  no  other  pub-  j  monly  clear  and  lucid,  not  only  the  more  compli- 
lication  so  well  calculated  to  fill  a  void  long  felt. —  cated  and  difficult  processes,  but  those  not  less  im- 
Medical  Examiner.  portant  ones,  the  most  simple  and  common.— B uffalo 

Tiie  book  is  strictly  practical,  and  describes  only  j  Medical  Journal . 
manipulations  or  methods  of  performing  the  nume-  j      The  country  practitioner  who  is  obliged  to  dis 


pense  his  own  medicines,  will  find  it  a  most  valuable 
assistant. — Monthly  Journal  and  Retrospect. 


rous  processes  the  pharmaceutist  has  to  go  through, 
in  the  preparation  and  manufacture  of  medicines, 
together  with  all  the  apparatus  and  fixtures  neces- 

MACKENSIE    (W.),    M .  D., 

Surgeon  Oculist  in  Scotland  in  ordinary  to  Her  Majesty,  Ac.  &c. 

A  PRACTICAL  TREATISE  OX  DISEASES  OF  THE  EYE.     To  which  is 

prefixed  an  Anatomical  Introduction  explanatory  of  a  Horizontal  Section  of  the  Human  Eyeball. 

Bv  THOMAS  WHARTON  JONES,  F.  R.  S.  From  the  Fourth  Revised  and  Enlarged  London  Edition. 

With  Notes  and  Additions  by  ADDINELL  HEWSON,  M.  D-,  Physician  to  Wills  Hospital.  &:c.  &c. 

In  one  very  large  and  handsome  octavo  volume,  with  plates  and  numerous  wood-cuts.  (Preparing.) 

The  reputation  which  this  work  has  universally  attained  will  be  enhanced  by  the  present  edition. 
Besides  the  thorough  revision  by  the  author  which  it  has  enjoyed  in  recently  passing  through  the 
press  in  London,  the  additions  by  the  editor  will  embrace  whatever  is  necessary  to  adapt  it  com 
pletely  to  the  wants  of  the  American  practitioner,  constituting  it  a  library  of  Ophthalmic  Medicine 
and  Surgery. 


22 


BLANCHARD    &    LEA'S    MEDICAL 


MACLISE   (JOSEPH),    SURGEON. 
SURGICAL   ANATOMY.     Forming   one  volume,   very  large   imperial   quarto. 

With  sixty-eight  large  and  splendid  Plates,  drawn  in  the  best  style  and  beautifully  colored.  Con 
taining  one  hundred  and  ninety  Figures,  many  of  them  the  size  of  life.  Together  with  copious 
and  explanatory  letter-press.  Strongly  and  handsomely  bound  in  extra  cloth,  being  one  of  the 
cheapest  and  best  executed  Surgica  works  as  yet  issued  in  this  country. 

Copies  can  be  sent  by  mail,  in  five  parts,  done  up  in  stout  covers. 

This  great  work  being  now  concluded,  the  publishers  confidently  present  it  to  the  attention  of  the 
profession  as  worthy  in  every  respect  of  their  approbation  and  patronage.  No  complete  work  of 
the  kind  has  yet  been  published  in  the  English  language,  and  it  therefore  will  supply  a  want  long 
felt  in  this  country  of  an  accurate  and  comprehensive  Atlas  of  Surgical  Anatomy  to  which  the 
student  and  practitioner  can  at  all  times  refer,  to  ascertain  the  exact  relative  position  of  the  various 
portions  of  the  human  frame  towards  each  other  and  to  the  surface,  as  well  as  their  abnormal  de 
viations.  The  importance  of  such  a  work  to  the  student  in  the  absence  of  anatomical  material,  and 
to  the  practitioner  when  about  attempting  an  operation,  is  evident,  while  the  price  of  the  book,  not 
withstanding  the  large  size,  beauty,  and  finish  of  the  very  numerous  illustrations,  is  so  low  as  to 
place  it  within  the  reach  of  every  member  of  the  profession.  The  publishers  therefore  confidently 
anticipate  a  very  extended  circulation  for  this  magnificent  work. 


One  of  the  greatest  artistic  triumphs  of  the  age 
in  Surgical  Anatomy. — British  American  Medical 
Journal, 

Too  much  cannot  be  said  in  its  praise;  indeed, 
we  have  not  language  to  do  it  justice.— Ohio  Medi 
cal  and  Surgical  Journal, 

The  most  admirable  surgical  atlas  we  have  seen. 
To  the  practitioner  deprived  of  demonstrative  dis 
sections  upon  the  human  subject,  it  is  an  invaluable 
companion. — N.  J.  Medical  Reporter. 

The  most  accurately  engraved  and  beautifully 
colored  plates  we  have  ever  seen  in  an  American 
book — one  of  the  best  and  cheapest  surgical  works 
ever  published.— Buffalo  Medical  Journal. 

It  is  very  rare  that  so  elegantly  printed,  so  well 
illustrated,  and  so  useful  a  work,  is  offered  at  so 
moderate  a  price. — Charleston  Medical  Journal, 

Its  plates  can  boast  a  superiority  which  places 
them  almost  beyond  the  reach  of  competition. — Medi 
cal  Examiner, 

Every  practitioner,  we  think,  should  have  a  work 
of  this  kind  within  reach. — Southern  Medical  and 
Surgical  Journal. 

No  such  lithographic  illustrations  of  surgical  re 
gions  have  hitherto,  we  think,  been  given. — Boston 
Medical  and  Surgical  Journal. 

As  a  surgical  anatomist,  Mr.  Maclise  has  proba 
bly  no  superior.— British  and  Foreign  Medico-Chi- 
rurgical  Review. 

Of  great  value  to  the  student  engaged  in  dissect 
ing,  and  to  the  surgeon  at  a  distance  from  the  means 


of  keeping  up  his  anatomical  knowledge. — Medical 
Times. 

The  mechanical  execution  cannot  be  excelled. — 
Transylvania  Medical  Journal. 

A  work  which  has  no  parallel  in  point  of  accu 
racy  and  cheapness  in  the  English  language. — N.  Y. 
Journal  of  Medicine. 

To  all  engaged  in  the  study  or  practice  of  their 
profession,  such  a  work  is  almost  indispensable. — 
Dublin  Quarterly  Medical  Journal. 

No  practitioner  whose  means  will  admit  should 
fail  to  possess  it. — Ranking' s  Abstract. 

Country  practitioners  will  find  these  plates  of  im 
mense  value. — N.  Y.  Medical  Gazette. 

We  are  extremely  gratified  to  announce  to  the 
profession  the  completion  of  this  truly  magnificent 
work,  which,  as  a  whole,  certainly  stands  unri 
valled,  both  for  accuracy  of  drawing,  beauty  of 
coloring,  und  all  the  requisite  explanations  of  the 
subject  in  hand.— The  New  Orleans  Medical  and 
Surgical  Journal. 

This  is  by  far  the  ablest  work  on  Surgical  Ana 
tomy  that  has  come  under  our  observation.  We 
know  of  no  other  work  that  would  justify  a  stu 
dent,  in  any  degree,  for  neglect  of  actual  dissec 
tion.  Jn  those  sudden  emergencies  that  so  often 
arise,  and  which  require  the  instantaneous  command 
of  minute  anatomical  knowledge,  a  work  of  this  kind 
keeps  the  details  of  the  dissecting-room  perpetually- 
fresh  in  the  memory. — The  Western  Journal  of  Medi 
cine  and  Surgery. 


The  very  low  price  at  which  this  work  is  furnished,  and  the  beauty  of  its  execution, 
require  an  extended  sale  to  compensate  the  publishers  for  the  heavy  expenses  incurred. 


MULLER  (PROFESSOR  J.),    M.D. 

PRINCIPLES  OF  PHYSICS  AND  METEOROLOGY.  Edited,  with  Addi 
tions,  by  R.  EGLESFELD  GRIFFITH,  M.  D.  In  one  large  and  handsome  octavo  volume,  extra 
cloth,  with  550  wood-cuts,  and  two  colored  plates. 

The  Physics  of  Mflller  is  a  work  superb,  complete.  |  tion  to  the  scientific  records  of  this  country  may  be 

jience 

supplied.     The  work  is 
of  surpassing  interest.    The  value  of  this  contribu- 


unique:  the  greatest  want  known  to  English  Science  j  duly  estimated  by  the  fact  that  the  cost  of  the  origi- 
coukl  not  have  been  better  supplied.     The  work  is  I  nal  drawings  and  engravings  alone  has  exceeded  the 


sum  of  £2,000.— Lancet. 


MAYNE  (JOHN),   M.  D.,  M.  R.  C.  S. 

A  DISPENSATORY  AND  THERAPEUTICAL  REMEMBRANCER.  Com 
prising  the  entire  lists  of  Materia  Mediea,  with  every  Practical  Formula  contained  m  the  three 
British  Pharmacopoeias.  With  relative  Tables  subjoined,  illustrating,  by  upwards  of  six  hundred 
and  sixty  examples,  the  Extemporaneous  Forms  and  Combinations  suitable  for  the  different 
Medicines.  Edited,  with  the  addition  of  the  Formulae  of  the  United  States  Pharmacopoeia,  by 
K.  EGLESFELD  GRIFFITH,  M.  D.  In  one  12mo.  volume,  extra  cloth,  of  over  300  large  pages. 


MATTEUCCI  (CARLO). 
LECTURES  ON  THE  PHYSICAL  PHENOMENA  OF  LIVING  BEINGS. 

Edited  by  J.  PEREIRA,  M.  D.     In  one  neat  royal  12mo.  volume,  extra  cloth,  with  cuts,  388  pages- 


AND   SCIENTIFIC    PUBLICATIONS. 


•23 


NEILL  (JOHN),   M.  D., 

Surgeon  to  the  Pennsylvania  Hospital,  &c.j  and 
FRANCIS  GURNEY   SMITH,   M.D., 

Professor  of  Institutes  of  Medicine  in  the  Pennsylvania  Medical  College. 

AN  ANALYTICAL  COMPENDIUM  OF  THE  VARIOUS  BRANCHES 

OF  MEDICAL  SCIENCE  ;  for  the  Use  and  Examination  of  Students.  Second  edition,  revised 
and  improved.  In  one  very  large  and  handsomely  printed  royal  12mo.  volume,  of  over  one 
thousand  pages,  with  three  hundred  and  fifty  illustrations  on  wood.  Strongly  bound  in  leather, 
with  raised  bands. 

The  speedy  sale  of  a  large  impression  of  this  work  has  afforded  to  the  authors  gratifying  evidence 
of  the  correctness  of  the  views  which  actuated  them  in  its  preparation.  In  meeting  the  demand 
for  a  second  edition,  they  have  therefore  been  desirous  to  render  it  more  worthy  of  the  favor  with 
which  it  has  been  received.  To  accomplish  this,  they  have  spared  neither  time  nor  labor  in  embo 
dying  in  it  such  discoveries  and  improvements  as  have  been  made  since  its  first  appearance,  and 
such  alterations  as  have  been  suggested  by  its  practical  use  in  the  class  and  examination-room. 
Considerable  modifications  have  thus  been  introduced  throughout  all  the  departments  treated  of  in 
the  volume,  but  more  especially  in  the  portion  devoted  to  the  "  Practice  of  Medicine,"  which  has 
been  entirely  rearranged  and  rewritten.  The  authors  therefore  again  submit  their  work  to  the 
profession,  with  the  hope  that  their  efforts  may  tend,  however  humbly,  to  advance  the  great  caus-e 
of  medical  education. 

Notwithstanding  the  enlarged  size  and  improved  execution  of  this  work,  the  price  has  not  been 
increased,  and  it  is  confidently  presented  as  one  of  the  cheapest  volumes  now  before  the  profession. 


Having  made  free  use  of  this  volume  in  our  ex 
aminations  of  pupils,  we  can  speak  from  experi 
ence  in  recommending  it  as  an  admirable  compend 
for  students,  and  as  especially  useful  to  preceptors 
who  examine  their  pupils.  It  will  save  the  teacher 
much  labor  by  enabling  him  readily  to  recall  all  of 
the  points  upon  whicp  his  pupils  should  be  ex 
amined.  A  work  of  this  sort  should  be  in  the  hands 
of  every  one  who  takes  pupils  into  his  office  with  a 
view  of  examining  them;  and  this  is  unquestionably 
the  best  of  its  class.  Let  every  practitioner  who  has 
pupils  provide  himself  with  it,  and  he  will  find  the 
labor  of  refreshing  his  knowledge  so  much  facilitated 
that  he  will  be  able  to  do  justice  to  his  pupils  at  very- 
little  cost  of  time  or  trouble  to  himself.— Transyl 
vania  Med.  Journal. 


In  the  rapid  course  of  lectures,  where  work  for 
the  students  is  heavy,  and  review  necessary  for  an 
examination,  a  compend  is  not  only  valuable,  but 
it  is  almost  a  sine  qua  non.  The  one  before  us  is, 
in  most  of  the  divisions,  the  most  unexceptionable 
of  all  books  of  the  kind  that  we  know  of.  The 
newest  and  soundest  doctrines  and  the  latest  im 
provements  and  discoveries  are  explicitly,  though 
concisely,  laid  before  the  student.  Of  course  it  is 
useless  for  us  to  recommend  it  to  all  last  course 
students,  but  there  is  a  class  to  whom  we  very 
sincerely  commend  this  cheap  book  as  worth  its 
weight  in  silver  —  that  class  is  the  graduates  in 
medicine  of  more  than  ten  years'  standing,  who 
have  not  studied  medicine  since.  They  will  perhaps 
find  out  from  it  that  the  science  is  not  exactly  now 
what  it  was  when  they  left  it  off. — The.  Stethoscope 

NELIGAN  (J.    MOORE),  M.  D.,  M.  R.  I.  A.,  &c. 
A   PRACTICAL   TREATISE    ON   DISEASES    OF   THE    SKIN.     In  one 

neat  royal  12mo.  volume,  of  334  pages. 

OWEN  (PROF.    R.), 

Author  of  "  Lectures  on  Comparative  Anatomy,"  "  Archetype  of  the  Skeleton,"  &c. 

ON  THE   DIFFERENT   FORMS   OF   THE  SKELETON,  AND  OF  THE 

TEETH.     One  vol.  royal  12mo.,  with  numerous  illustrations.     (Now  Ready.) 
The  name  of  the  distinguished  author  is  a  sufficient  guarantee  that  this  little  volume  will  prove 
a  satisfactory  manual  and  guide  to  all  students  of  Comparative  Anatomy  and  Osteology.     The  im 
portance  of  this  subject  in  geological  investigations  will  also  render  this  work  a   most  valuable 
assistant  to  those  interested  in  that  science. 


PHILLIPS  (BENJAMIN),   F.  R.  S.,  &c. 

SCROFULA ;    its  Nature,  its  Prevalence,  its  Causes,  and  the  Principles  of  its 
Treatment.    In  one  volume,  octavo,  with  a  plate. 


PANCOAST  (J.),  M.  D., 
Professor  of  Anatomy  in  the  Jefferson  Medical  College,  Philadelphia,  &c. 

OPERATIVE  SURGERY;  or,  A  Description  and  Demonstration  of  the  various 
Processes  of  the  Art;  including  all  the  New  Operations,  and  exhibiting  the  State  of  Surgical 
Science  in  its  present  advanced  condition.  Complete  in  one  royal  4to.  volume,  of  380  pages  of 
letter-press  description  and  eighty  large  4to.  plates,  comprising  486  illustrations.  Second  edition, 
improved. 
Blanchard  &  Lea  having  become  the  publishers  of  this  important  book,  have  much  pleasure  in 

offering  it  to  the  profession. 


This  excellent  work  is  constructed  on  the  model 
of  the  French  Surgical  Works  by  Velpeau  and  Mal- 
gaigne;  and,  so  far  as  the  English  language  is  con 


cerned,  we  are  proud  as  an  American  to  say  that, 

OF  ITS  KIND  IT  HAS  NO  SUPERIOR. — N.  Y.  Journal  of 

Medicine. 


PARKER   (LANGSTON), 

Surgeon  to  the  Queen's  Hospital,  Birmingham. 

THE  MODERN  TREATMENT  OF  SYPHILITIC  DISEASES,  BOTH  PRI 
MARY  AND  SECONDARY;  comprising  the  Treatment  of  Constitutional  and  Confirmed  Syphi 
lis,  by  a  safe  and  successful  method.  With  numerous  Cases,  Formulae,  and  Clinical  Observa 
tions.  From  the  Third  and  entirely  rewritten  London  edition.  In  one  neat  octavo  volume. 
(Now  Ready.) 


BLANC  HARD    &    LEA'S   MEDICAL 


(Now  Complete.') 

PEREIRA  (JONATHAN),  M.  D.,  F.  R.  S.,  AND  L.  S. 
THE    ELEMENTS    OF    MATERIA    MEDICA    AND    THERAPEUTICS. 

Third  American  edition,  enlarged  and  improved  by  the  author;  including  Notices  of  most  of  the 
Medicinal  Substances  in  use  in  the  civilized  world,  and  forming  an  Encyclopaedia  of  Materia 
Medica.  Edited,  with  Additions,  by  JOSEPH  CARSON,  M.  D.,  Professor  of  Materia  Medica  and 
Pharmacy  in  the  University  of  Pennsylvania.  In  two  very  large  octavo  volumes  of  2100  pages, 
on  small  type,  with  over  four  hundred  and  fifty  illustrations. 
VOLUME  I. — Lately  issued,  containing  the  Inorganic  Materia  Medica,  over  800  pages,  with  145 

illustrations. 

VOLUME  II. — Now  ready,  embraces  the  Organic  Materia  Medica,  and  forms  a  very  large  octavo 
volume  of  1250  pages,  with  two  plates  and  three  hundred  handsome  wood-cuts. 
The  present  edition  of  this  valuable  and  standard  work  will  enhance  in  every  respect  its  well- 
deserved  reputation.  The  care  bestowed  upon  its  revision  by  the  author  may  be  estimated  by  the 
fact  that  its  size  has  been  increased  by  about  five  hundred  pages.  These  additions  have  extended 
to  every  portion  of  the  work,  and  embrace  not  only  the  materials  afforded  by  the  recent  editions  of 
the  pharmacopoeias,  but  also  all  the  important  information  accessible  to  the  care  and  industry  of 
the  author  in  treatises,  essays,  memoirs,  monographs,  and  from  correspondents  in  various  parts  of 
the  globe.  In  this  manner  the  work  comprises  the  most  recent  and  reliable  information  respecting 
all  the  articles  of  the  Materia  Medica,  their  natural  and  commercial  history,  chemical  and  thera 
peutical  properties,  preparation,  uses,  doses,  and  modes  of  administration,  brought  up  to  the  present 
lime,  with  a  completeness  not  to  be  met  with  elsewhere.  A  considerable  portion  of  the  work 
which  preceded  the  remainder  in  London,  has  also  enjoyed  the  advantage  of  a  further  revision  by 
the  author  expressly  for  this  country,  and  in  addition  to  this  the  editor,  Professor  Carson,  has  made 
whatever  additions  appeared  desirable  to  adapt  it  thoroughly  to  the  U.  S.  Pharmacopoeia,  and  to 
the  wants  of  the  American  profession.  An  equal  improvement  will  likewise  be  observable  in  every 
department  of  its  mechanical  execution.  It  is  printed  from  new  type,  on  good  white  paper,  with  a 
greatly  extended  and  improved  series  of  illustrations. 

Gentlemen  who  have  the  first  volume  are  recommended  to  complete  their  copies  without  delay. 
The  first  volume  will  no  longer  be  sold  separate. 


When  we  remember  that  Philology,  Natural  His 
tory,  Botany,  Chemistry,  Physics,  and  the  Micro 
scope,  are  all  brought  forward  to  elucidate  the  sub 
ject,  one  cannot  fail  to  see  that  the  reader  has  here 
a  work  worthy  of  the  name  of  an  encyclopedia  of 
Materia  Medica.  Our  own  opinion  of  its  merits  is 
that  of  its  editors,  and  also  that  of  the  -whole  profes 
sion,  both  of  this  and  foreign  countries— namely, 
"  that  in  copiousness  of  details,  in  extent,  variety, 
and  accuracy  of  information,  and  in  lucid  explana 
tion  of  difficult  and  recondite  subjects,  it  surpasses 
all  other  works  on  Materia  Medica  hitherto  pub 
lished."  We  cannot  close  this  notice  without  allud 
ing  to  the  special  additions  of  the  American  editor, 
which  pertain  to  the  prominent  vegetable  produc 
tions  of  this  country,  and  to  the  directions  of  the 
United  States  Pharmacopeia,  in  connection  with  all 
the  articles  contained  in  the  volume  which  are  re- 


Medica,  although  completed  under  the  supervision  of 
others,  is  by  far  the  most  elaborate  treatise  in  the 
English  language,  and  will,  while  medical  literature 
is  cherished,  continue  a  monument  alike  honorable 
to  his  genius,  as  to  his  learning  and  industry. — 
American  Journal  of  Pharmacy,  March,  1854. 

The  work,  in  its  present  shape,  and  so  far  as  can 
be  judged  from  the  portion  before  the  public,  forms 
the  most  comprehensive  and  complete  treatise  on 
materia  medica  extant  in  the  English  language. — 
Dr.  Pereira  has  been  at  great  pains  to  introduce 
into  his  work,  not  only  all  the  information  on  the 
natural,  chemical,  and  commercial  history  of  medi 
cines,  which  might  be  serviceable  to  the  physician 
and  surgeon,  but  whatever  might  enable  his  read 
ers  to  understand  thoroughly  the  mode  of  prepar 
ing  and  manufacturing  various  articles  employed 
fe7re~dToTfit7¥hen7usTraU^  \  either  for  preparing  medicines,  or  for  certain  pur 

j    ^i   •  i'*..  i         -r-k         ^  it    i  '       r*/-»o*ic     in     tViA    nrta    nnnnpptpn    \*n  t"  h     rrmtpria     mp(.if>; 


and  this  edition  by  Dr.  Carson  cannot  well  be  re- 
garded  in  any  other  light  than  that  of  a  treasure 
which  should  be  found  in  the  library  of  every  physi 
cian. — New  York  Journal  of  Medical  and  Collateral 
Science,  March,  1854. 

The  third  edition  of  his  "  Elements  of  Materia 


poses  in  the  arts  connected  with  materia  niecaea 
and  the  practice  of  medicine.  The  accounts  of  the 
physiological  and  therapeutic  effects  of  remedies  aye 
given  with  great  clearness  and  accuracy,  and  in  a 
manner  calculated  to  interest  as  well  as  instruct 
the  reader. — The  Edinburgh  Medical  and  Surgical 
Journal. 


PEASELEE  (E.   R.),   M.  D., 

Professor  of  Anatomy  and  Physiology  in  Dartmouth  College,  &c. 

HUMAN  HISTOLOG-Y,  in  its  applications  to  Physiology  and  General  Pathology; 

designed  as  a  Text-Book  for  Medical  Students.    With  numerous  illustrations.     In  one  handsome 

royal  12mo.  volume.     (Preparing.} 

The  subject  of  this  work  is  one,  the  growing  importance  of  which,  as  the  basis  of  Anatomy  and 
Physiology,  demands  for  it  a  separate  volume.  The  book  will  therefore  supply  an  acknowledged 
deficiency  in  medical  text-books,  while  the  name  of  the  author,  and  his  experience  as  a  teacher  for 
the  last  thirteen  years,  is  a  guarantee  that  it  will  be  thoroughly  adapted  to  the  use  of  the  student. 


PIRRIE  (WILLIAM),  F.  R.  S.  E., 

Professor  of  Surgery  in  the  University  of  Aberdeen. 

THE    PRINCIPLES   AND   PllACTICE   OF   SURGERY.     Edited  by  JOHN 

NEILL,  M.  D.,  Demonstrator  of  Anatomy  in  the  University  of  Pennsylvania,  Surgeon  to  the 
Pennsylvania  Hospital,  &c.  In  one  very  handsome  octavo  volume,  of  780  pages,  with  316  illus- 
tratioiu-i.  (Just  Issued.) 


We  know  of  no  other  surgical  work  of  a  reason 
able  size,  wherein  there  is  so  much  theory  and  prac 
tice,  or  where  subjects  are  more  soundly  or  clearly 
taught.—  The  Stethoscope. 

There  is  scarcely  a  disease  of  the  bone  or  soft 
parts,  fracture,  or  dislocation,  that  is  not  illustrated 
by  accurate  wood-engravings.  Then,  again,  every 
instrument  employed  by  the  surgeon  is  thus  repre 
sented.  These  engravings  are  not  only  correct,  but 
really  beautiful,  showing  the  astonishing  degree  of 
perfection  to  which  the  art  of  wood-engraving  has 


arrived.  Prof.  Pirrie,  in  the  work  before  us,  has 
elaborately  discussed  the  principles  of  surgery,  and 
a  safe  and  effectual  practice  predicated  upon  them. 
Perhaps  no  work  upon  this  subject  heretofore  issued 
is  so  full  upon  the  science  of  the  art  of  surgery. — 
Nashville  Journal  of  Medicine  and  Surgery. 

One  of  the  best  treatises  on  surgery  in  the  English 
language. — Canada  Med.  Journal. 

Our  impression  is,  that,  as  a  manual  for  students, 
Pirrie's  is  the  best  work  extant.— Western  Med.  and 
Surg.  Journal. 


AND    SCIENTIFIC    PUBLICATIONS.  25 


RAMS  BOTH  AM  (FRANCIS  H  .),   M.D. 
THE  PRINCIPLES  AND  PRACTICE  OF  OBSTETRIC  MEDICINE  AND 

SURGERY,  in  reference  to  the  Process  of  Parturition.  A  new  and  enlarged  edition,  thoroughly 
revised  by  the  Author.  With  Additions  by  W.  V.  KEATING,  M.  1).  In  one  large  and  handsome 
imperial  octavo  volume,  with  sixty-four  beautiful  Plates,  and  numerous  Wood-cuts  in  the  text, 
containing  in  all  nearly  two  hundred  large  and  beautiful  figures.  (Now  Ready.) 

In  calling  the  attention  of  the  profession  to  the  new  edition  of  this  standard  work,  the  publishers 
would  remark  that  no  efforts  have  been  spared  to  secure  for  it  a  continuance  and  extension  of  the 
remarkable  favor  with  which  it  has  been  received.  The  last  London  issue,  which  was  considera 
bly  enlarged,  has  received  a  further  revision  from  the  author,  especially  for  this  country.  Its  pas 
sage  through  the  press  here  has  been  supervised  by  Dr.  Keating,  who  has  made  numerous  addi 
tions  with  a  view  of  presenting  more  fully  whatever  was  necessary  to  adapt  it  thoroughly  to 
American  modes  of  practice.  In  its  mechanical  execution,  a  like  superiority  over  former  editions 
will  be  found.  The  plates  have  all  been  re-engraved  in  a  new  and  beautiful  style  ;  many  additional 
illustrations  have  been  introduced,  and  in  every  point  of  typographical  finish  it  will  be  found  one  of 
the  handsomest  issues  of  the  American  press.  In  its  present  improved  and  enlarged  form  the  pub 
lishers  therefore  confidently  ask  for  it  a  place  in  every  medical  library,  as  a  text-book  for  the  student, 
or  a  manual  for  daily  reference  by  the  practitioner. 

From  Prof.  Hodge,  of  the  University  of  Pa. 

To  the  American  public,  it  is  most  valuable,  from  its  intrinsic  undoubted  excellence,  and  as  being 
Hie  best  authorized  exponent  of  British  Midwifery.  Its  circulation  will,  I  trust,  be  extensive  throughout 
our  country. 


We  recommend  the  student  who  desires  to  mas 
ter  this  difficult  subject  with  the  least  possible 
trouble,  to  possess  himself  at  once  of  a  copy  of  this 
work. — American  Journal  of  the  Med.  Sciences. 


When  the  whole  profession  is  thus  unanimous 
in  placing  such  a  work  in  the  very  first  rank  as 
regards  the  extent  and  correctness  of  all  the  details 
of  the  theory  and  practice  of  so  important  a  branch 


It  stands  at  the  head  of  the  long  list  of  excellent  I  of  learning,  our  commendation  or  condemnation 
istetric  works  published  in  the  last  few  years  in  would  be  of  little  consequence;  but  regarding  it 
reat  Britain,  Ireland,  and  the  Continent  of  Eu-  a,s.  the.  most  useful  of  all  works  of  the  kind,  we 


obst« 

Great 

rope.  We  consider  this  book  indispensable  to  the 
library  of  every  physician  engaged  in  the  practice 
of  midwifery. — Southern  Med.  and  Surg.  Journal. 


think  it  but  an  act  of  justice  to  urge  its   claims 
upon  the  profession. — N.  0.  Med.  Journal. 


RICORD  (P.),   M.  D., 
Surgeon  to  the  Hopital  du  Midi,  Paris,  &c. 

ILLUSTRATIONS  OF  SYPHILITIC  DISEASE.  Translated  from  the  French, 

by  THOMAS  F.  BETTON,  M.  D.  With  the  addition  of  a  History  of  Syphilis,  and  a  complete  Bib 
liography  and  Formulary  of  Remedies,  collated  and  arranged,  by  PAUL,  B.  GODDARD,  M.  D.  With 
fifty  large  quarto  plates,  comprising  one  hundred  and  seventeen  beautifully  colored  illustrations. 
In  one  large  and  handsome  quarto  volume. 

BY   THE   SAME   AUTHOR.       (Now  Ready.) 

A  TREATISE  ON  THE  VENEREAL  DISEASE.     By  JOHN  HUNTER,  F.  R.  S. 

With  copious  Additions,  by  PH.  RICORD,  M.  D.  Edited,  with  Notes,  by  FREEMAN  J.  BUMSTEAD, 
M.  D.  In  one  handsome  octavo  volume,  with  plates. 

Every  one  will  recognize  the  attractiveness  and  [      In  the  notes  to  Hunter,  the  master  substitutes  him- 
value  which  this  work  derives  from  thus  preseniing  |  self  for  his  interpreters,  and  gives  his  original  thought? 


the  opinions  of  these  two  masters  side  by  side.  But, 
it  must  be  admitted,  what  has  made  the  fortune  of 
the  book,  i?  ihe  fact  that  it  contains  the  "most  com 
plete  embodiment  of  the  veritable  doctrines  of  the 
Hopital  du  Midi,"  which  has  ever  been  made  public. 
The  doctrinal  ideas  of  M.  Ricord,  ideas  which,  if  not 
universally  adopted,  are  incontestably  dominant,  have 
heretofore  only  been  interpreted  by  more  or  less  skilful 
secretaries,  sometimes  accredited  and  sometimes  not. 


to  the  world,  in  a  summary  form  it  is  true,  but  in  a 
lucid  and  perfectly  intelligible  manner.  In  conclu 
sion  we  can  say  that  this  is  incontestably  the  best 
treatise  on  syphilis  with  which  we  are  acquainted, 
and.  as  we  do  not  often  employ  the  phrase,  we  may 
be  excused  for  expressing  the  hope  that  it  may  find 
a  place  in  the  library  of  every  physician — Virginia 
Med.  and  Surg  Journal. 


BY    THE    SAME    AUTHOR. 

LETTERS  ON  SYPHILIS,  addressed  to  the  Chief  Editor  of  the  Union  Medicale. 
With  an  Introduction,  by  Amedee  Latour.  Translated  by  W.  P.  Lattimore,  M.  D.  In  one  neat 
octavo  volume. 

Blanchard  &  Lea  are  now  the  publishers  of  this  valuable  work. 

From  the  Translator's  Preface. 

To  those  who  have  listened  to  the  able  and  interesting  lectures  of  our  author  at  the  Hopital  du 
Midi,  this  volume  will  need  no  commendation;  while  to  those  who  have  not  had  the  pleasure  to 
which  we  allude,  the  book  will  commend  itself  by  the  truths  it  contains,  told  as  they  are  in  the 
same  inimitable  style  in  which  M.  Ricord  delivers  his  clinical  lectures. 

BY   THE    SAME    AUTHOR. 

A  PRACTICAL  TREATISE  ON  VENEREAL  DISEASES.     With  a  There- 

peutical  Summary  and  Special  Formulary.    Translated  by  SIDNEY  DOANE,  M.  D.    Fourth  edition. 
One  volume,  octavo,  340  pages. 


BLANCHARD    &    LEA'S    MEDICAL 


RIGBY  (EDWARD),   M.  D., 

Physician  to  the  General  Lying-in  Hospital,  &c. 

A   SYSTEM   OF   MIDWIFERY.     With   Notes  and   Additional  Illustrations. 

Second  American  Edition.     One  volume  octavo,  422  pages. 


ROYLE  (J.  FORBES),   M .  D. 
MATERIA  MEDICA  AND  THERAPEUTICS;  including  the  Preparations  of 

the  Pharmacopoeias  of  London,  Edinburgh,  Dublin,  and  of  the  United  States.  With  many  new 
medicines.  Edited  by  JOSEPH  CARSON,  M.  D.,  Professor  of  Materia  Medica  and  Pharmacy  in 
the  University  of  Pennsylvania.  With  ninety-eight  illustrations.  In  one  large  octavo  volume, 
of  about  seven  hundred  pages. 


This  work  is,  indeed,  a  most  valuable  one,  and 
will  fill  up  an  important  vacancy  that  existed  be 
tween  Dr.  Pereira's  most  learned  and  complete 
system  of  Materia  Medica,  and  the  class  of  pro 


ductions  on  the  other  extreme,  which  are  neces 
sarily  imperfect  from  their  small  extent. — British 
and  Foreign  Medical  Review, 


SKEY  (FREDERICK  C.),   F.  R.  S.,  &c. 
OPERATIVE  SURGERY.     In  one  very  handsome  octavo  volume  of  over  650 

pages,  with  about  one  hundred  wood-cuts. 


Its  literary  execution  is  superior  to  most  surgical 
treatises.  It  abounds  in  excellent  moral  hints,  and 
is  replete  with  original  surgical  expedients  and  sug 
gestions. — Buffalo  Med.  and  Surg.  Journal. 

With  high  talents,  extensive  practice,  and  a  long 
experience,  Mr.  Skey  is  perhaps  competent  to  the 
task  of  writing  a  complete  work  on  operative  sur 
gery. — Charleston  Med.  Journal. 


We  cannot  withhold  from  this  work  our  high  com 
mendation.  Students  and  practitioners  will  find  it  an 
invaluable  teacher  and  guide  upon  every  topic  con 
nected  with  this  department.— N.  Y.  Medical  Ga 
zette. 

A  work  of  the  very  highest,  importance — a  work 
by  itself.— London  Med.  Gazette. 


SHARPEY  (WILLIAM),    M.D.,    JONES    QUAIN,    M.D.,   AND 
RICHARD   QUAIN,    F.  R.  S.,  &c. 

HUMAN  ANATOMY.     Revised,  with  Notes  and  Additions,  by  JOSEPH  LEIDY, 

M.  D.     Complete  in  two  large  octavo  volumes,  of  about  thirteen  hundred  pages.     Beautifully 
illustrated  with  over  five  hundred  engravings  on  wood. 


It  is  indeed  a  work  calculated  to  make  an  era  in 
anatomical  study,  by  placing  before  the  student 
every  department  of  his  science,  with  a  view  to 


^Ve  have  no  hesitation  in  recommending  this  trea 
tise  on  anatomy  as  the  most  complete  on  that  sub 
ject  in  the  English  language;  and  the  only  one, 


the   relative  importance  of  each  ;    and  so  skilfully     perhaps,   in  any  language,  which  brings  the   state 
have  the  different  parts  been  interwoven,  that  no  i  of   knowledge   forward  to   the  most   recent  disco- 
one  who  makes  this  work  the  basis  of  his  studies,  ~,     ~.-   ,        .,    .--  .    __  .  ~ 
\vill   hereafter  have  any  excuse  for   neglecting   or 
undervaluing  any  important  particulars  connected 
with    the    structure    of    the    human    frame;     and 
whether  the  bias  of  his  mind  lead  him   in  a  more 
especial  manner  to  surgery,  physic,  or  physiology, 
he  will  find  here  a  work  at  once  so  comprehensive 
and  practical  as  to  defend  him  from  exclusiveness 
on    the   one   hand,   and    pedantry  on    the  other. — 
Monthly  Journal   and   Retrospect  of  the   Medical 
Sciences. 


veries. — The  Edinburgh  Med.  and  Surg.  Journal. 

Admirably  calculated  to  fulfil  the  object  for  which 
it  is  intended.— Prom'nciaZ  Medical  Journal. 

The  most  complete  Treatise  on  Anatomy  in  the 
English  language. — Edinburgh  Medical  Journal. 

There  is  no  work  in  the  English  language  to  be 
preferred  to  Dr.  Quain's  Elements  of  Anatomy. — 
London  Journal  of  Medicine. 


SMITH  (HENRY    H.),  M.D.,   AND    HO  RN  ER  (W  I  LLI  AM   E.),    M.D. 

AN  ANATOMICAL  ATLAS,  illustrative  of  the  Structure  of  the  Human  Body. 
In  one  volume,  large  imperial  octavo,  with  about  six  hundred  and  fifty  beautiful  figures. 


These  figures  are  well  selected,  and  present  a 
complete  and  accurate  representation  of  that  won 
derful  fabric,  the  human  body.  The  plan  of  this 
Atlas,  which  renders  it  so  peculiarly  convenient 
for  the  student,  and  its  superb  artistical  execution, 
have  been  already  pointed  out.  We  must  congratu 


late  the  student  upon  the  completion  of  this  Atlas, 
as  it  is  the  most  convenient  work  of  the  kind  that 
has  yet  appeared  ;  and  we  must  add,  the  very  beau 
tiful  manner  in  which  it  is  "  got  up"  is  so  creditable 
to  the  country  as  to  be  flattering  to  our  national 
pride. — American  Medical  Journal. 


SARGENT  (F.  W.),   M.  D. 
ON  BANDAGING  AND   OTHER   POINTS   OF   MINOR   SURGERY.     In 

one  handsome  royal  12mo.  volume  of  nearly  400  pages,  with  128  wood-cuts. 

The  very  best  manual  of  Minor  Surgery  we  have  }  We  have  carefully  examined  this  work,  and  find  it 
seen;  an  American  volume,  with  nearly  four  hundred  well  executed  and  admirably  adapted  to  the  use  of 
pages  of  good  practical  lessons,  illustrated  by  about  the  student.  Besides  the  subjects  usually  embraced 
one  hundred  sind  thirty  wood-cuts.  In  these  days  in  works  on  Minor  Surgery,  there  is  a  short  chapter 
of  "trial,"  when  a  doctor's  reputation  hangs  upon  on  bathing,  another  on  anaesthetic  agents,  and  an 
a  clove  hitch,  or  the  roll  of  a  bandage,  it  would  be  appendix  of  formulae.  The  author  has  given  an  ex- 
well,  perhaps,  to  carry  such  a  volume  as  Mr.  Sar-  eel  lent  work  on  this  subject,  and  his  publishers  have 
gent's  always  in  our  coat-pocket,  or,  at  all  events,  illustrated  and  printed  it  in  most  beautiful  style.— 
to  listen  attentively  to  his  instructions  at  home.—  The  Charleston  Medical  Journal. 
Buffalo  Med.  Journal. 


STANLEY  (EDWARD). 
A  TREATISE  ON  DISEASES  OF  THE   BONES.     In  one  volume,  octavo, 

extra  cloth,  286  pages. 


AND    SCIENTIFIC    PUBLICATIONS.  27 

STILLE  (ALFRED),  M.  D. 
PRINCIPLES  OF  THERAPEUTICS.     In  one  handsome  volume.  (Preparing.) 

SIMON   (JOHN),  F.  R.  S. 
GENERAL    PATHOLOGY,    as   conducive  to  the   Establishment  of  Rational 

Principles    for  the   Prevention  and  Cure  of  Disease.     A  Course  of  Lectures  delivered  at  St. 
Thomas's  Hospital  during-  the  summer  Session  of  1850.     In  one  neat  octavo  volume. 


SMITH   (TYLER  W.),   M.  D., 

Lecturer  on  Obstetrics  in  the  Hunterian  School  of  Medicine. 

ON   PARTURITION,    AND   THE    PRINCIPLES    AND    PRACTICE    OF 

OBSTETRICS.     In  one  large  duodecimo  volume,  of  400  pages. 


SIBSON    (FRANCIS),    M.  D., 

Physician  to  St.  Mary's  Hospital. 

MEDICAL  ANATOMY.  Illustrating  the  Form,  Structure,  and  Position  of  the 
Internal  Organs  in  Health  and  Disease.  In  large  imperial  quarto,  with  splendid  colored  plates. 
To  match  "Maclise's  Surgical  Anatomy."  (I?i  Press.) 

SOLLY  (SAMUEL),    F.  R.  S. 

THE  HUMAN  BRAIN;  its  Structure,  Physiology,  and  Diseases.  With  a 
Description  of  the  Typical  Forms  of  the  Brain  in  the  Animal  Kingdom.  From  the  Second  and 
much  enlarged  London  edition.  In  one  octavo  volume,  with  120  wood-cuts. 

SCHOEDLER  (FRIEDRICH),   PH.D., 

Professor  of  the  Natural  Sciences  at  Worms,  &c. 

THE   BOOK   OF   MATURE;    an  Elementary  Introduction  to  the  Sciences  of 

Physics,  Astronomy.  Chemistry,  Mineralogy,  Geology,  Botany,  Zoology,  and  Physiology.  First 
American  edition,  with  a  Glossary  and  other  Additions  and  Improvements;  from  the  second 
English  edition.  Translated  from  the  sixth  German  edition,  by  HENRY  MEDLOCK,  F.  C.  S.v&c. 
In  one  thick  volume,  small  octavo,  of  about  seven  hundred  pages,  with  679  illustrations  on  wood. 
Suitable  for  the  higher  Schools  and  private  students.  (Now  Heady.) 


This  volume,  as  its  title  shows,  covers  nearly  all 
the  sciences,  and  embodies  a  vast  amount  of  informa 
tion  for  instruction.  No  other  work  that  we  have 


seen  presents  the  reader  with  so  wide  a  range  of  ele 
mentary  knowledge,  with  so  full  illustrations,  at  so 
cheap  a  rate.—Silliman-s  Journal,  Nov.  1853. 


TAYLOR  (ALFRED  S.),  M .  D.,  F.  R.  S., 

Lecturer  on  Medical  Jurisprudence  and  Chemistry  in  Guy's  Hospital. 

MEDICAL  JURISPRUDENCE.     Third  American,  from  the  fourth  and  improved 

English  Edition.    With  Notes  and  References  to  American  Decisions,  by  EDWARD  HARTSHORNE, 
M.  D.     In  one  large  octavo  volume,  of  about  seven  hundred  pages.     (Just  issued.) 

reference,  that  would  be  more  likely  to  afford  the  aid 
desired.     We  therefore  recommend  it  as  the  best  and 


We  know  of  no  work  on  Medical  Jurisprudence 
which  contains  in  the  same  space  anything  like  the 
same  amount  of  valuable  matter. — N.  Y.  Journal  of 
Medicine. 

The  American  editor  has  appended  several  im 
portant  facts,  the  whole  constituting  by  far  the  best, 
most  reliable,  and  interesting  treatise  on  Medical 
Jurisprudence,  and  one  that  we  cannot  too  strongly 
recommend  to  all  who  desire  to  become  acquainted 
with  the  true  and  correct  exposition  of  this  depart 
ment  of  medical  literature. — Northern  Lancet. 


afest  manual  for  daily  use. — American  Journal  of 
Medical  Sciences. 

We  have  heretofore  had  reason  to  refer  to  it  in 
terms  of  commendation,  and  need  now  only  state 
that,  in  the  edition  before  us,  the  author  has  com 
pletely  revised  the  whole  work,  making  many  addi 
tions  and  alterations,  and  brought  it  fully  up  to  the 
present  state  of  knowledge.  The  task  of  the  Ameri 
can  editor  has  been  to  present  all  the  important 


No  work  upon  the   subject  can  be  put  into  the     facts  and  cases  that  have  recently  occurred  in  our 


hands  of  students  either  of  law  or  medicine  which 


own  country,  bearing  on   the   subjects  treated  of. 


will  engage  them  more  closely  or  profitably  ;  and  j  No  better  work  can  be  placed  in  the  hands  of  the 
none  could  be  offered  to  the  busy  practitioner  of  j  physician  or  jurist. — St.  Louis  Medical  and  Surgical 
either  calling,  for  the  purpose  of  casual  or  hasty  •  Journal. 

BY    THE    SAME    AUTHOR. 

ON  POISONS,  IN  RELATION  TO   MEDICAL  JURISPRUDENCE   AND 

MEDICINE.    Edited,  with  Notes  and  Additions,  by  R.  E.  GRIFFITH,  M.  D.    In  one  large  octavo 
volume,  of  688  pages. 


The  most  elaborate  work  on  the  subject  that  our 
literature  possesses. — British  and  Foreign  Medico- 
Chirurgical  Review. 

It  contains  a  vast  body  of  facts,  which  embrace 
all  that  is  important  in  toxicology,  all  that  is 
necessary  to  the  guidance  of  the  medical  jurist,  and 
all  that  can  be  desired  by  the  lawyer.  —  Medico- 


a.  —  - 

Chiru-rgical  Review.  {  N.  Y.  Annalist  • 


One  of  the  most  practical  and  trustworthy  works 
on  Poisons  in  our  language. — Western  Journal  of 
Medicine . 

It  is,  so  far  as  our  knowledge  extends,  incompa 
rably  the  best  upon  the  subject;  in  the  highest  de 
gree  creditable  to  the  author,  entirely  trustworthy, 
and  indispensable  to  the  student  and  practitioner. — 


THOMSON  (A.  T.),  M.  D.,  F.  R.  S.,  &c. 
DOMESTIC  MANAGEMENT   OF   THE   SICK   ROOM,  necessary  in  aid  of 

Medical  Treatment  for  the  Cure  of  Diseases.     Edited  by  R.  E.  GRIFFITH,  M.  D.     In  one  large 
royal  12mo.  volume,  with  wood-cuts,  360  pages. 


28  BL AN CHARD&   LEA'S    MEDICAL 

TOMES  (JOHN),    F.  R.  S. 
A  MANUAL  OF  DENTAL  PRACTICE.     Illustrated  by  numerous  engravings 

on  wood.     In  one  handsome  volume.     (Preparing.} 

TODD  (R.  B.),   M.  D.,  AND  BOWMAN  (WILLIAM),   F.  R.  S. 
PHYSIOLOGICAL    ANATOMY   AND    PHYSIOLOGY   OF   MAN.     With 

numerous  handsome  wood-cuts.    Paris  I,  II,  and  III,  in  one  octavo  volume,  552  pages.     Part  IV 

will  complete  the  work. 

The  distinguishing  peculiarity  of  this  work  is,  that  the  authors  investigate  for  themselves  every 
fact  asserted  ;  and  it  is  the  immense  labor  consequent  upon  the  vast  number  of  observations  re 
quisite  to  curry  out  this  plan,  which  has  so  long  delayed  the  appearance  of  its  completion.  The 
first  portion  ot  Part  IV,  with  numerous  original  illustrations,  was  published  in  the  Medical  News 
and  Library  for  1853,  and  the  completion  will  be  issued  immediately  on  its  appearance  in  London. 
Those  who  have  subscribed  since  the  appearance  of  the  preceding  portion  of  the  work  can  have 
the  three  pacts  by  mail,  on  remittance  of  $2  50  to  the  publishers. 

WATSON    (THOMAS),    M.  D.,    &c. 
LECTURES    ON    THE    PRINCIPLES    AND    PRACTICE    OF    PHYSIC. 

Third  American,  from  the  last  London  edition.  Revised,  with  Additions,  by  D.  FRANCIS  CONDIE, 
M.  D.,  author  of  a  "Treatise  on  the  Piseases  of  Children,"  &c.  In  one  octavo  volume,  of  nearly 
eleven  hundred  large  pages,  strongly  bound  with  raised  bands. 


To  say  that  it  is  the  very  best  work  on  the  sub 
ject  now  extant,  is  but  to  echo  the  sentiment  of  the 
medical  press  throughout  the  country.  —  N.  O. 
Medical  Journal. 

Of  the  text-books  recently  republished  Watson  is 
very  justly  the  principal  favorite.—  Holmes's  Rep. 
to  Nat.  Med.  Assoc. 

By  universal  consent  the  work  ranks  among  the 
very  best  text-books  in  our  language.  —  Illinois  and 
Indiana  Med.  Journal. 

Regarded  on  all  hands  as  one  of  the  very  best,  if 


Confessedly  one  of  the  very  best  works  on  the 
principles  and  practice  of  physic  in  the  English  or 
any  other  language. — Med.  Examiner. 

Asa  text- book  it  has  no  equal ;  as  a  compendium 
of  pathology  and  practice  no  superior. — New  York 
Annalist. 

We  know  of  no  work  better  calculated  for  being 

E laced  in  the  hands  of  the  student,  and  for  a  text- 
ook;  on  every  impojtfant  point  the  author  seems 
to   have  posted   up  hH    knowledge   to   the  day.— 
Amer.  Med.  Journal. 

One  of  the  most   practically  useful  books    that 


not  the  very  best,  systematic  treatise  on  practical  j  ever  was  presented  to   the   student.  —  N.  Y.  Med. 
medicine  extant.—  St.  Louis  Med.  Journal.  \  Journal. 


WALSHE   (W.    H.)f    M.  D., 

Professor  of  the  Principles  and  Practice  of  Medicine  in  University  College,  London. 

DISEASES    OF    THE    HEART,    LUNGS,    AND    APPENDAGES;    their 

Symptoms  and  Treatment.     In  one  handsome  volume,  large  royal  12mo.,  512  pages. 
We  consider  this  as  the  ablest  work  in  the  En-  1  the  author  being  the  first  stethoscopist  of  the  day. — 
glish  language,  on  the  subject  of  which  it  treats;  |  Charleston  Medical  Journal. 

WHAT    TO   OBSERVE 
AT    THE    BEDSIDE    AND    AFTER   DEATH,    IN    MEDICAL    CASES. 

Published  under  the  authority  of  the  London  Society  for  Medical  Observation.     A  new  American, 

from  the  second  and  revised  London  edition.     In  one  very  handsome  volume,  royal  12mo.,  extra 

cloth.     (Note  Ready.} 

The  demand  which  has  so  rapidly  exhausted  the  first  edition  of  this  little  work,  shows  that  the 
advantages  it  offers  to  the  profession  have  been  duly  appreciated,  and  has  stimulated  the  authors  to 
render  it  more  worthy  of  its  reputation.  It  has  therefore  been  thoroughly  revised,  and  such  im 
provements  (among  which  is  a  section  on  TREATMENT)  have  been  made  as  further  experience  in 
its  use  has  shown  to  be  desirable. 

We  hail  the  appearance  of  this  book  as  the  grand  !  given   to   the  world,   through   a   small    but   useful 

desideratum. — Charleston  Medical  Journal.  \  medical  organization,  a  cheap  but  invaluable  book. 

...  ,   ,      ,       ™,         ,    ,     i  We  do  advise  every  reader  of  this  notice  to  buy  it 

This   is   truly  a  very  capital  book.     The  whole  ,  am,  uge  it      Unless  he  is  S()  yain  ftg  f()  iinagine  hfm. 
medical  world  will  reap  advantages  from  its  puoli-    gelf  superior  to  the  ordinary  human  capacity,  he  will 
cation.    The  medical  journals  will   soon  show  its  |  in  six    months  see  its  inestimable  advantages.— 
influence  on  the  character  of  the  "  Reports  of  Cases"  i  stethoscope. 
which  they  publish.    Drs.  Bullard  and  Walshe  have  ] 

WILDE   (W.    R.), 

Surgeon  to  St.  Mark's  Ophthalmic  and  Aural  Hospital,  Dublin. 

AURAL  SURGERY,  AND  THE  NATURE  AND  TREATMENT  OF  DIS- 

EASES  OF  THE  EAR.  In  one  handsome  octavo  volume,  with  illustrations.  (Now  Ready.) 
So  little  is  generally  known  in  this  country  concerning  the  causes,  symptoms,  and  treatment  ot 
aural  affections,  that  a  practical  and  scientitie  work  on  that  subject,  from  a  practitioner  of  Mr. 
Wilde's  great  experience,  cannot  fail  to  be  productive  of  much  benefit,  by  attracting  attention 
to  this  obscure  class  of  diseases,  which  too  frequently  escape  attention  until  past  relief.  The  im 
mense  number  of  cases  which  have  come  under  Mr.  Wilde's  observation  for  many  years,  have 
afforded  him  opportunities  rarely'enjoyed  for  investigating  this  branch  of  medical  science,  and  his 
work  may  thereto  re  be  regarded  as  of  the  highest  authority. 


This  work  certainly  contains  more  information  on 
the  subject  to  which  it  is  devoted  than  any  other 
wilh  which  we  are  acquainted.  We  feel  grateful  to 
the  author  for  his  manful  effort  to  rescue  this  depart 
ment  of  surgery  from  the  hands  of  the  empirics  who 
nearly  monopolize  it.  We  think  he  has  successfully 


shown"  that  aural  diseases   are  not  beyond   the  re- |  Med.  Journal. 
sources  of  art;  that  they  are  governed  by  the  same 


laws,  and  amenable  to  the  same  general  methods  01 
treatment  as  other  morbid  processes.  The  work  ig 
not  written  to  supply  the  cravings  of  popular  patro 
nage,  but  it  is  wholly  addressed  to  the  profession, 
and  bears  on  every  page  the  impress  of  the  reflections 
of  a  sagacious  and  practical  surgeon. —  Va.  Surg.  and 


AND    SCIENTIFIC    PUBLICATIONS.  29 


WILSON    (ERASMUS),   M.D.,    F.  R.  S., 

Lecturer  on  Anatomy,  London. 

A  SYSTEM  OF  HUMAN  ANATOMY,  General  and  Special.  Fourth  Ameri 
can,  from  the  last  English  edition.  Edited  hy  PAT;L  B.  GODDARD,  A.  M.,  M.  D.  With  two  hun 
dred  and  fifty  illustrations.  Beautifully  printed,  in  one  large  octavo  volume,  of  nearly  six  hun 
dred  pages. 


In  many,  if  not  all  the  Colleges  of  the  Union,  it 
has  become  a  standard  text-book.  This,  of  itself, 
is  sufficiently  expressive  of  its  value.  A  work  very 
desirable  to  the  student;  one,  the  possession  of 
which  will  greatly  facilitate  his  progress  in  the 
study  of  Practical  Anatomy. — New  York  Journal  of 
Medicine. 


It  offers  to  the  student  all  the  assistance  that  can 
be  expected  from  such  a  work. — Medical  Examiner. 

The  most  complete  and  convenient  manual  for  the 
student  we  possess. — American  Journal  of  Medical 
Science. 


In   every   respect,   this  work  as   an   anatomical 
guide  for  the  student  and  practitioner,  merits  our 
Its  author  ranks  with  the  highest  on  Anatomy. —  I  warmest  and  most  decided  praise. — London  Medical 
Southern  Medical  and  Surgical  Journal.  I  Gazette. 

BY   THE   SAME   AUTHOR. 

THE  DISSECTOR;  or,  Practical  and  Surgical  Anatomy.  Modified  and  Re 
arranged,  by  PAUL  BECK  GODDARD,  M.  L>.  A  new  edition,  with  Revisions  and  Additions.  la 
one  large  and  handsome  volume,  royal  12mo.,  with  one  hundred  and  fifteen  illustrations. 

In  passing  this  work  again  through  the  press,  the  editor  has  made  such  additions  and  improve 
ments  as  the  advance  of  anatomical  knowledge  has  rendered  necessary  to  maintain  the  work  in  the 
high  reputation  which  it  has  acquired  in  the  schools  of  the  United  States,  as  a  complete  and  faithful 
guide  to  the  student  of  practical  anatomy.  A  number  of  new  illustrations  have  been  added,  espe 
cially  in  the  portion  relating  to  the  complicated  anatomy  of  Hernia.  In  mechanical  execution  the 
work  will  be  ibund  superior  to  former  editions. 

BY    THE   SAME   AUTHOR. 

ON  DISEASES  OF  THE  SKIN.  Third  American,  from  the  third  London 
edition.  In  one  neat  octavo  volume,  of  about  five  hundred  pages,  extra  cloth.  (Just  Issued.) 
Also,  to  be  had  done  up  with  fifteen  beautiful  steel  plates,  of  which  eight  are  exquisitely  colored  ; 
representing  the  Normal  and  Pathological  Anatomy  of  the  Skin,  together  with  accurately  colored 
delineations  of  more  than  sixty  varieties  of  disease,  most  of  them  the  size  of  nature.  The  Plates 
are  also  for  sale  separate,  done  up  in  boards. 

The  increased  size  of  this  edition  is  siifflcient  evidence  that  the  author  has  not  been  content 
with  a  mere  republication,  but  has  endeavored  to  maintain  the  high  character  of  his  work  as  the 
standard  text-book  on  this  interesting  and  difficult  class  of  diseases.  He  has  thus  introduced  such 
new  matter  as  the  experience  of  the  last  three  or  four  years  has  suggested,  and  has  made  such 
alterations  as  the  progress  of  scientific  investigation  has  rendered  expedient.  The  illustrations  have 
a-lso  been  materially  augmented,  the  number  of  plates  being  increased  from  eight  to  sixteen. 


Of  these  plates  it  is  impossible  to  speak  too  highly . 
The  representations  of  the  various  forms  of  cuta 
neous  disease  are  singularly  accurate,  and  the  color 
ing  exceeds  almost  anything  we  have  met  with  hi 
point  of  delicacy  and  finish. — British  and  Foreign 
Medical  Review. 


The  "Diseases  of  the  Skin,"  by  Mr.  Erasmus 
Wilson,  may  now  be  regarded  as  the  standard  work 
in  that  department  of  medical  literature.  The 
plates  by  which  this  edition  is  accompanied  leave 
nothing  to  be  desired,  so  far  as  excellence  of  delinea 
tion  and  perfect  accuracy  of  illustration  are  con 
cerned. — Medico-Chirurgical  Review. 

BY   THE    SAME    AUTHOR. 

ON    CONSTITUTIONAL    AND    HEREDITARY    SYPHILIS,   AND    ON 

SYPHILITIC  ERUPTIONS.    In  one  small  octavo  volume,  beautifully  printed,  with  four  exqui 
site  colored  plates,  presenting  more  than  thirty  varieties  of  syphilitic  eruptions. 


Dr.  Wilson's  views  on  the  general  subject  of 
Syphilis  appear  to  us  in  the  main  sound  and  judi 
cious,  and  we  commend  the  book  as  an  excellent 
monograph  on  the  subject.  Dr.  Wilson  has  pre 
sented  us  a  very  faithful  and  lucid  description  of 
Syphilis  and  has  cleared  up  many  obscure  points  in 


connection  with  its  transmissibility,  pathology  and 
sequelae.  His  facts  and  references  will,  we  are  satis 
fied,  be  received  as  decisive,  in  regard  to  many 
questiones  vexatae.  They  appear  to  us  entitled  to 
notice  at  some  length. — Medical  Examiner. 


BY   THE   SAME    AUTHOR.       (NoiV  Ready.) 

HEALTHY  SKIN;  A  Popular  Treatise  on  the  Skin  and  Hair,  their  Preserva- 

tion  and  Management.     Second  American,  from  the  fourth  London  edition.     One  neat  volume, 
royal  12mo.,  with  numerous  illustrations. 

Copies  can  be  had  done  up  in  paper  covers  for  mailing,  price  75  cents. 


WHITEHEAD  (JAMES),    F.  R.  C.  S.,    &c. 
THE  CAUSES  AND  TREATMENT  OF  ABORTION  AND   STERILITY; 

being  the  Result  of  an  Extended  Practical  Inquiry  into  the  Physiological  and  Morbid  Conditions 

of  the  Uterus.     Second  American  Edition.     In  one  volume,  octavo,  308  pages.     (Now  Ready.) 

The  simple  title  of  this  work  gives  a  very  imper-  :  this  department  of  our  profession,  that  the  praeti- 

fect  idea  of  its  contents.     The  subject  of  sterility  !  tioner  who  does  not  consult  the  recent  works  on  the 

occupies  a  mere  fraction  of  space,  and  upwards  of  i  complaints  of  females,  will  soon  find  himself  in  the 

one-half  of  the  whole  volume  is  taken  up  with  an  I  rear  of  his  more  studious  brethren.     This  is  one  of 

elaborate  account  of  menstruation  as  a  physiological     the  works  which  must  be  studied  by  those  who 

process,  and  of  the  disorders  which  its  deviations  I  would  know  what  the  present  state  of  our  knowledge 

from  health  are  apt  to  produce. — Medical  Chirurg.  \  is  respecting  the  causes  and  treatment  of  abortion 

Revieiv.  j  and  sterility. — The  Western  Journal  of  Medicine  and 

Such  are  the  advances  made  from  year  to  year  in    Surgery. 


30  BLANCHARD    &    LEA'S    MEDICAL 

WEST   (CHARLES),    M.  D., 

Physician  to  the  Hospital  for  Sick  Children,  &c. 

LECTURES    ON   TPIE    DISEASES    OF  INFANCY  AND   CHILDHOOD. 

Second  American,  from  the  Second  and  Enlarged  London  edition.     In  one  volume,  octavo,  of 
nearly  five  hundred  pages.    (Now  Ready.) 

From  the  Preface  to  the  Second  Edition. 

In  the  preparation  of  the  second  edition  of  these  Lecture?,  the  whole  work  has  been  carefully 
revised.  A  few  formula;  have  been  introduced  and  a  minute  alphabetical  index  has  been  appended 
while  additions  amounting  altogether  to  fifty  pages,  have  been  made,  wherever  I  felt  that  more 
extended  observation,  or  more  careful  reflection  had  enabled  me  to  supply  some  of  those  deficiencies 
which  I  am  well  aware,  are  still  far  too  numerous.  The  work  now  contains  the  result  of  640 
observations,  and  199  post-mortem  examinations,  chiefly  made  among  16,276  children  who  came 
under  my  notice  during  the  ten  years  of  my  connection  with  the  Children's  Infirmary  in  Lambeth. 


We  take  leave  of  Dr.  \Vest  with  great  respect  for 
his  attainments,  a  due  appreciation  of  his  acute 
powers  of  observation,  and  a  deep  sense  of  obliga 
tion  for  this  valuable  contribution  to  our  profes 
sional  literature.  His  book  is  undoubtedly  in  many 
respects  the  best  we  possess  on  diseases  of  children. 
The  extracts  we  have  given  will,  we  hope,  satisfy 
our  readers  of  its  value;  and  yet  in  all  candor  we 
must  say  that  they  are  even  inferior  to  some  other 
parts,  the  length  of  which  prohibited  our  entering 
upon  them.  That  the  book  will  shortly  be  in  the 
hands  of  most  of  our  readers  we  do  not  doubt,  and  it 
will  give  us  much  pleasure  if  our  strong  recommend 
ation  of  it  may  contribute  towards  the  result. — The 
Dublin  Quarterly  Journal  of  Medical  Science, 

Dr.  West  has  placed  the  profession  under  deep  ob 
ligation  by  this  able,  thorough,  and  finished  work 


upon  a  subject  which  almost  daily  taxes  to  the  ut 
most  the  skill  of  the  general  practitioner.  He  has 
with  singular  felicity  threaded  his  way  through  all 
the  tortuous  labyrinths  of  the  difficult  subject  he  has 
undertaken  to  elucidate,  and  has  in  many  of  the 
darkest  corners  left  a  light,  for  the  benefit  of  suc 
ceeding  travellers,  which  will  never  be  extinguished. 
Not  the  least  captivating  feature  in  this  admirable 
performance  is  its  easy,  conversational  style,  which 
acquires  force  from  its  very  simplicity,  and  leaves 
an  impression  upon  the  memory,  of  the  truths  it 
conveys,  as  clear  and  refreshing  as  its  own  purity. 
The  author's  position  secured  him  extraordinary  fa 
cilities  for  the  investigation  of  children's  diseases, 
and  his  powers  of  observation  and  discrimination 
have  enabled  him  to  make  the  most  of  these  great 
advantages. — Nashville  Medical  Journal, 


BY  THE  SAME  AUTHOR.       (Now  Ready.) 

AN  ENQUIRY  INTO  THE  PATHOLOGICAL  IMPORTANCE  OF  ULCER- 

ATION  OF  THE  OS  UTERI.     Being  the  Croonian  Lectures  for  the  year  1854.    In  one  neat 
octavo  volume,  extra  cloth. 


WILLIAMS  (C.   J.  B.),    M.  D.,    F.  R.  S., 

Professor  of  Clinical  Medicine  in  University  College,  London,  &c. 

PRINCIPLES  OF  MEDICINE;  comprising  General  Pathology  and  Therapeu 
tics,  and  a  brief  general  view  of  Etiology,  Nosology,  Semeiology,  Diagnosis,  Prognosis,  and 
Hygienics.  Edited,  with  Additions,  by  MEREDITH  CLYMER,  M.  D.  Fourth  American,  from  the 
last  and  enlarged  London  edition.  In  one  octavo  volume,  of  476  pages.  (Now  Ready.) 

This  new  edition  has  been  materially  enlarged  and  brought  up  by  the  editor. 

It  possesses  the  strongest  claims  to  the  attention  of  the  medical  student  and  practitioner,  from 
the  admirable  manner  in  which  the  various  inquiries  in  the  different  branches  of  pathology  are 
investigated,  combined,  and  generalized  by  an  experienced  practical  physician,  and  directly  applied 
to  the  investigation  and  treatment  of  disease. — EDITOR.'S  PREFACE. 


The  best  exposition  in  our  language,  or,  we  be 
lieve,  in  any  language,  of  rational  medicine,  in  its 
present  improved  and  rapidly  improving  state. — 
British  and  Foreign  Medico-Chirurg.  Review, 


Few  books  have  proved  more  useful,  or  met  with 
a  more  ready  sale  than  this,  and  no  practitioner 
should  regard  his  library  as  complete  without  it. 
— Ohio  Med.  and  Surg.  Journal. 


BY    THE   SAME    AUTHOR. 

A  PRACTICAL  TREATISE   ON   DISEASES   OF  THE   RESPIRATORY 

ORGANS;  including  Diseases  of  the  Larynx,  Trachea,  Lungs,  and  Pleurae.     With  numerous 
Additions  and  Notes,  by  M.  CLYMER,  M.  D.    With  wood-cuts.    In  one  octavo  volume,  pp.  508. 


YOUATT  (WILLIAM),  V.  S. 
THE    HORSE.      A  new  edition,  with  numerous  illustrations;    together  with  a 

general  history  of  the  Horse;  a  Dissertation  on  the  American  Trotting  Horse ;  how  Trained  and 
Jockeyed;  an  Account  of  his  Remarkable  Performances;  and  an  E*say  on  the  Ass  and  t  lie  Mule. 
By  J.  S.  SKINNER,  formerly  Assistant  Postmaster-General,  and  Editor  of  the  Turf  Register. 
One  large  octavo  volume. 

BY   THE    SAME   AUTHOR. 

THE   DOG.     Edited  by  E.  J.  LEWIS,   M.  D.     With   numerous   and  beautiful 
illustrations.     In  one  very  handsome  volume,  crown  8vo.,  crimson  cloth,  gilt. 


AND    SCIENTIFIC    PUBLICATIONS. 


31 


B.  &  L.  subjoin  a  condensed  list  of  their  publications  in  general  and  educational 
literature,  of  which  more  detailed  catalogues  will  be  furnished  on  application. 


HISTORY  AND   BIOGRAPHY. 


BROWNING'S  HISTORY  OF  THE  HUGUE 
NOTS,  1  vol.  8vo. 

CAMPBELL'S  (LORD)  LIVES  OF  THE  LORD 
CHANCELLORS  OF  ENGLAND,  from  the  earl 
iest  Times  to  the  Reign  of  George  IV.  In  seven 
handsome  crown  octavo  volumes,  extra  cloth  or 
half  niorocco. 

CAMPBELL'S  (LORD)  LIVES  OF  THE  CHIEF 
JUSTICES  OF  ENGLAND,  from  the  Norman 
Conquest.  In  two  handsome  crown  octavo  vols., 
to  match  the  "Chancellors." 

DIXON'S  LIFE  OF  WILLIAM  PENN.  A  new 
work.  1  vol.  royal  12mo.,  extra  cloth. 

GRAHAME'S  COLONIAL  HISTORY  OF  THE 
UNITED  STATES.  2  vols.  8vo.  A  new  edition. 

GUIZOT'S  LIFE  OF  CROMWELL.  Two  large 
vols.,  royal  12mo.  (Now  ready.) 

HERVEY'S  MEMOIRS  OF  GEORGE  II.  2  vols. 
roval  T2mo.,  extra  cloth. 

HUGHES'S  OUTLINES  OF  SCRIPTURE  GEO 
GRAPHY  AND  HISTORY,  L  vol.,  royal  12mo., 
with  colored  maps.  (Just  issued.) 

INGERSOLL'S  HISTORY  OF  THE  LATE  WAR. 

KENNEDY'S   LIFE   OF    WILLIAM    WIRT.    2d 

edition,  2  vols.  royal  12mo.,  extra  cloth,  with  Por 
trait. 

Same  work,  library  edition.  2  vols.  8vo. 

KAVANAGH  S  WOMAN  IN  FRANCE  IN  THE 
EIGHTEENTH  CENTURY.  1  vol.  royal  12mo., 
extra  cloth. 

LOUIS  BLANC'S  FRANCE  UNDER  LOUIS  PHI 
LIPPE,  1830-1840.  2  vols.  crown  8vo.,  extra  cloth. 


LOUIS  BLANC'S  FRENCH  REVOLUTION.  1  vel. 

crown  Svo  .  extra  cloth. 
MARSH  (MRS.)  ROMANTIC  HISTORY  OF  THE 

HUGUENOTS.    2  vols.  royal  r2mo..  extra  cloth 
NIEBUHRS  ANCIENT  HISTORY.  By  LEONHARD 

SCHMITZ.    In  ihree  handsome  crown  octavo  vols., 

(Lately  Issued.) 
PARDOE'S  FRANCIS  THE  FIRST.    2  vols.  royal 

12mo.,  extra  cloth. 
PALGRAVES    NORMANDY  AND    ENGLAND. 

In  three  vols.  crown  8vo.,  (Preparing.) 
RUSH'S  COURT  OF  LONDON.    1vol.  Svo. 
RANKE'S  HISTORY  OF   THE   REFORMATION 

IN  GERMANY.    To  he  complete  in  1  vol.  Svo. 
RANKES  HISTORY  OF  THE  OTTOMAN   AND 

SPANISH  EMPIRES.    Svo.     Price  50  cents. 
RUSSEL'S   LIFE   OF   CHARLES    JAMES   FOX. 

2  vols.,  handsome  royal  12mo.    (Now  ready.) 
Same  Work,  Second  Series.    (Preparing  ) 
STRICKLAND'S    LIVES  OF  THE  QUEENS  OF 

ENGLAND,  from   the   Norman   Conquest.    Com 
plete  in  6  handsome  crown  Svo.  volumes,  various 

styles  of  binding. 
STRICKLAND^    LIVES  OP  THE  QUEENS  OF 

HENRY  VIII.    In  one  handsome  crown  Svo.  vol., 

extra  cloth,  various  styles. 
STRICKLAND'S  LIFE  OF  QUEEN  ELIZABETH. 

In  one  handsome  crown  8vo.  volume,  extra  cloth, 

various  styles. 
STEINMETZ'S    HISTORY  OF    THE    JESUITS. 

2  vols.  crown  8vo.,  extra  cloth. 


MISCELLANEOUS. 


ACTON  (MRS.)  MODERN  COOKERY.    Edited  by 

Mrs.  S  J.  HALE.    1  handsome  volume,  royal  12mo., 

extra  cloth,  with  illustrations. 
ADDISON  ON  CONTRACTS,  and  on    Parties  to 

Actions, ex  contractu.    1  large  octavo  volume,  law 

sheep. 
BUFPUM'S    SIX    MONTHS     IN     THE     GOLD 

MINES.    1  vol.  royal  12mo.,  extra  cloth  or  paper, 

50  cents. 

BAIRD'S  WEST  INDIES  AND  NORTH  AMERI 
CA.    1  vol.  royal  12mo..  extra  cloth. 
CLATER  ON  THE  DISEASES  OF  HORSES.  By 

SKINNER.    1  vol  12rno. 
CLATER'S  CATTLE  AND  SHEEP  DOCTOR.    1 

vol.  I2rno.,  cuts. 
DON  QUIXOTE.    With  numerous  illustrations  by 

Johannot.    2  vols.  Svo.  cloth,  or  half  morocco. 
ENCYCLOPAEDIA   OF    GEOGRAPHY.    In  three 

octavo  vols. .many  cuts  and  maps,  various  bindings. 
ENCYCLOPAEDIA  AMERICANA.     14  vols.  Svo., 

various  bindings. 

Vol.  14.  bringing  the  work  up  to  1846,  sold  separate. 
EXPLORING  EXPEDITION,  NARRATIVE  OF. 

In  six  vol?.,  imperial  quarto,  with  several  hundred 

plates,  maps,  and  wood-cuts. 
EVANS'S  SUGAR-PLANTER'S  MANUAL.  1  vol. 

Svo  ,  extra  cloth,  plates. 
ERMAN'S  TRAVELS  IN  SIBERIA    2  vols.  royal 

12mo..  extra  cloth. 
FIELDING'S  SELECT  WORKS.    In  one  vol.  Svo. 

cloth,  or  4  parts,  paper. 
FLETCHER'S  NOTES  FROM  NINEVEH.    1  vol. 

royal  12mo.,  extra  cloth. 
HAVVKER    ON  SHOOTING.    Edited  by  PORTER. 

With  plates  and  cuts.    1  vol.  Svo.,  beautiful  extra 

cloth,  new  edition.  (Just  Issued.) 
HOLTHOUSE'S    LAW  DICTIONARY.    By  PEK 
ING-TON.    1  vol.  larpe  l'2rno..  law  sheep. 
JOHNSON'S    DICTIONARY    OF    GARDENING 

By  LANDRETH.    1  vol.  large  royal  12mo.,  650  pages, 

many  cuts. 
LANGUAGE  OF  FLOWERS.    8th  edition.    1  vol. 

18mo.,  colored  plates,  crimson  cloth,  gilt. 
LEWIS'S  HINTS  TO  SPORTSMEN.    1  vol.  royal 

12mo.,  extra  cloth,  illustrated. 


LYNCH'S  NARRATIVE  OF  THE  U.  S.  EXPE 
DITION  TO  THE  DEAD  SEA  AND  RIVER 
JORDAN.  1  large  octavo  volume,  with  numerous 
plates  and  maps. 

Same  work,  condensed  edition,  in  neat  royal  12mo. 

MACFARLANE'S  TURKEY  AND  ITS  DES 
TINY.  2  vols.  royal  12rno.,  extra  cloth. 

MACKAY'S  TRAVELS  IN  THE  UNITED 
S  PATES.  2  vols.  royal  12mo.,  extra  cloth. 

MARTINEAU'S  EASTERN  LIFE.  1  vol.  crown 
Svo. .extra  cloth. 

MARTINEAU'S  HOUSEHOLD  EDUCATION.  1 
vol.  royal  12mo.,  extra  cloth. 

PAGET'S  HUNGARY  AND  TRANSYLVANIA. 
2  vols.  royal  12mo.,  extra  cloth. 

PULSZKY'S  HUNGARIAN  LADY.  1  vol.  royal 
12mo..  extra  cloth. 

PICC1OLA— The  Prisoner  of  Fenestrella.  Illustrated 
edition,  with  cuts,  royal  12mo.,  beautiful  crimson 
cloth. 

Same  work,  fancy  paper,  price  50  cents. 

READINGS  FOR  THE  YOUNG  FROM  SIR 
WALTER  SCOTT,  2  vols.  royal  ISmo.,  extra 
crimson  cloth,  plates. 

SELECT  WORKS  OF  TOBIAS  SMOLLETT 
Cloth  or  paper. 

SHAW'S  OUTLINES  OF  ENGLISH  LITERA 
TURE.  1  large  vol.  royal  12mo.,  extra  cloth. 

SMALL  BOOKS  ON  GREAT  SUBJECTS.  In  three 
neat  volumes,  royal  ISmo.,  extra  cloth. 

SAM  SLICK'S  NEW  WORK— WISE  SAWS  AND 
MODERN  INSTANCES.  1  vol.  12mo.,  (Now 
Ready.) 

THOMSON'S  DOMESTIC  MANAGEMENT  OF 
THE  SICK  ROOM.  1vol.  12mo. 

WHEATON'S  INTERNATIONAL  LAW.  1  vol. 
large  8vo.,  law  sheep,  or  extra  cloth.  3d  edition, 
much  improved. 

YOUATT  ON  THE  HORSE,  &c.  By  SKINNER.  1 
vol.  8vo.,  many  cuts. 

YOUATT  ON  THE  DOG.  With  plates.  1  vol. 
crown  Svo..  beautiful  crimson  cloth. 

YOUATT  ON  THE  PIG.  1  vol.  12mo.,  extra  cloth, 
with  cuts. 

Same  work  in  paper,  price  50  cents. 


NATURAL    SCIENCE. 


AMERICAN  ORNITHOLOGY.  By  PRINCECHARLES 

BONAPARTE.   In  four  handsome  folio  volumes,  with 

beautiful  colored  plates. 
ARNOTT  S  ELEMENTS  OF  PHYSICS.  New  Edi- 

itipn.  By  ISAAC  HAYS,  M.  D.  In  one  octavo  volume, 

with  200  illustrations. 


BRODERIP'S  ZOOLOGICAL  RECREATIONS.    1 

vol.  royal  12mo.,  extra  cloth. 
BOWMAN  S    PRACTICAL   CHEMISTRY.     1vol. 

royal  12mo..  extra  cloth  ;  cuts. 
BIRD'S  NATURAL  PHILOSOPHY.    1  vol.  royal 

12rno.,  with  many  cuts. 


32 


BLANCHARD    &    LEA'S    SCIENTIFIC  PUBLICATIONS. 


NATURAL  SCIENCE.— Continued. 


BE  ALE  ON  THE  LAWS  OF  HEALTH  IN  RE 
LATION  TO  MIND  AND  BODY.  1  vol.  royal 
12mo.,  extra  cloth. 

BREWSTER'S  TREATISE  ON  OPTICS.  1  vol. 
12rno..  cuts. 

CARPENTER'S  GENERAL  AND  COMPARA 
TIVE  PHYSIOLOGY.  With  numerous  wood 
cuts.  1  vol.  large  Svo.,  new  edition.  (Preparing.) 

CARPENTER  ON  THE  MICROSCOPE.  Hand 
somely  illustrated.  (Preparing.) 

DANA  ON  CORALS.  1  vol.  royal  4to.,  extra  cloth, 
with  wood-cuts. 

Atlas  to  do .,  large  imperial  folio,  half  morocco,  with 
over  60  magnificent  colored  plates. 

DE  LA  HECHE'S  GEOLOGICAL  OBSERVER. 
1  large  vol.  frvo.  over  300  cuts,  (Now  Ready  ) 

FOWNES'S  RECENT  WORK  ON  CHEMISTRY. 
New  edition.  By  BRIDGES.  1  vol.  12mo.,  many 
cuts,  sheep  or  extra  cloth. 

GRAHAM'S  ELEMENTS  OF  CHEMISTRY.  Large 
Svo..  many  cuts.  (Part  I,  lately  issued,  Part  II, 

GREGOR!  ON  ANIMAL  MAGNETISM,  i  vol. 

royal  12mo. 

GRIFFITH'S  CHEMISTRY  OF  THE  FOUR  SEA 
SONS.  1  vol.  12mo., many  cuts. 

GRIFFITH'S  MEDICAL  BOTANY.  1  vol.  large 
8vo.,  extra  cloth,  nearly  400  cuts. 

HERSCHEL'S  OUTLINES  OF  ASTRONOMY. 
1  vol.  crown  8vo..  ex.cl..  with  plates  and  wood  cuts. 

HUMBOLDT'S  ASPECTS  OF  NATURE,  ad  edi 
tion.  1  large  vol.  royal  12mo.,  extra  cloth. 

HANDBOOKS  ,  OF  NATURAL  PHILOSOPHY 
AND  ASTRONOMY.  By  DIONYSIUS  LARDNER. 
3  thick  vols.  royal  12mo.,  with  1000  wood-cuts. 


HALE'S  ETHNOLOGY  AND  PHILOLOGY  OF 
THE  U.  S.  EXPLORING  EXPEDITION.  1  vol. 
royal  4to.,  extra  cloth. 

JOHNSTON'S  PHYSICAL  ATLAS  OF  NATU 
RAL  PHENOMENA.  In  one  large  and  handsome 
imperial  4to.  vol.,  half  bound  in  morocco,  witli  26 
maps,  beautifully  colored. 

KNAPP'S  TECHNOLOGY,  OR  CHEMISTRY 
APPLIED  TO  THE  ARTS  AND  TO  MANU 
FACTURES.  Translated  by  Ronalds.  Edited  by 
Johnson.  Vol.  I.,  with  244  large  wood  engravings. 
Vol.  II.,  large  8vo.,  with  250  wood  engravings. 

MULLER'S  PHYSICS  AND  METEOROLOGY.  1 
vol.  large  Svo  ,  2  colored  plates,  and  550  wood-cuts. 

MILLWRIGHT'S  AND  MILLER'S  GUIDE.  By 
OUVER  EVANS.  In  one  vol.  Svo. .sheep,  many  plates. 

MATTEUCCI  ON  PHYSICAL  PHENOMENA  OF 
LIVING  BEINGS.  1  vol.  royal  12mo.,  ex.  cl.,  cuts. 

ORR'S  CIRCLE  OF  THE  SCIENCES,  royal  12mo.. 
with  numerous  illustrations,  containing  Animal 
and  Vegetable  Physiology,  by  Dr.  Bushnan.  The 
Different  Forms  of  the  Skeleton,  by  Prof.  Owen. 
Physical  Geography  and  Geology. by  Prof.  Ansted. 
Natural  Philosophy,  by  Rev.  W.Mitchell,  &c.  &c. 

SOMERVILLKS  PHYSICAL  GEOGRAPHY. 
New  edition.  1  large  vol.  royal  12mo..  extra  cloth. 

SCHOEDLER  AND  MEDLOCK'S  BOOK  OF  NA 
TURE.  With  Additions  and  Improvements  In 
one  thick  volume,  crown  Svo.,  with  over  679  illus 
trations. 

WEISBACII'S  PRINCIPLES  OF  THE  MECHA 
NICS  OF  MACHINERY  AND  ENGINEERING. 
2  large  octavo  volumes,  extra  cloth,  900  beautiful 
wood  engravings. 


EDUCATIONAL  WORKS. 


ARNOTT'S  ELEMENTS  OF  PHYSICS.  New  edi 
tion.  Complete  in  1  vol.  Svo  ,  many  illustrations. 

BOLMAR'S  FRENCH  SERIES,  consisting  of:  — 
LEVIZAC'S    FRENCH  GRAMMAR,  1  volume, 

12mo.,  sheep. 
PERRIN'S  FABLES,  with  KEY.  1  vol.  12mo.,  half 

bound. 

COLLOQUIAL  PHRASES,  1  vol.  18mo.,  hf.  bound. 
A  VENTURES  DE  TELEMAQUE,  1  vol.  12mo., 

half  bound. 

KEY  to  do.  do.  do. 

FRENCH  VERBS,  1vol.  12mo.,  half  bound. 

BAIRD'S  CLASSICAL  MANUAL.  An  Epitome  of 
Ancient  Geography,  Mythology,  Antiquities,  and 
Chronology.  1  vol.  royal  ISrno.,  extra  cloth. 

Same  work,  half  bound,  embossed  leather  backs. 

BUSHNAN'S  PHYSIOLOGY  OF  ANIMAL  AND 
VEGETABLE  LIFE.  A  new  and  popular  work. 
1  vol.  royal  12mo.  with  illustrations.  (Just  Ready.) 

BIRD'S  ELEMENTS  OF  NATURAL  PHILOSO 
PHY.  1  vol.  royal  12mo.,  sheep,  or  ext.  cl.  372  cuts. 

BUTLER'S  ATLAS  OF  ANCIENT  GEOGRAPHY. 
Revised  edition.  1  vol.  Svo.  half  bound,  21  colored 
maps. 

BUTLER'S  GEOGRAPHIA  CLASSICA.  Revised 
edition;  1  vol.  12mo.,  half  bound. 

BREWSTER'S  TREATISE  ON  OPTICS.  With 
additions.  By  BACHE.  1  vol.  12mo.,  halfbound,  cuts. 

BROWNE'SGREEK  CLASSICAL  LITERATURE. 
1  vol.  crown  Svo., extra  cloth. 

BROWNE'S  ROMAN  CLASSICAL  LITERA 
TURE.  1vol.  crown  Svo.,  ex.  cloth.  (Now  Ready.) 

FOSTER'S  HANDBOOK  OF  MODERN  EURO 
PEAN  LITERATURE.  1  vol.  royal  12mo., ex.  cl. 

FOWNE'S  CHEMISTRY  FOR  STUDENTS.  New 
edition.  By  BRIDGES.  1vol. royal  12mo.,  many  cuts, 
extra  cloth,  or  sheep. 

GRAHAM'S  ELEMENTS  OF  CHEMISTRY.  2d 
edition,  enlarged.  Edited  by  BRIDGES.  Svo.  many 
cuts.  Part  I.,  lately  issued.  Part  II.,  preparing. 

HERSCHEL'S  OUTLINES  OF  ASTRONOMY.  A 
new  edition.  With  numerous  plates  and  wood 
cuts.  1  vol.  crown  Svo.,  extra  cloth. 

HUGHES'S  OUTLINES  OF  SCRIPTURE  GEO 
GRAPHY  AND  HISTORY,  1  vol.,  royal  12mo., 
with  colored  maps.  (Just  issued.) 


I  JOHNSTON'S  ATLAS  OF  PHYSICAL  GEOGRA 
PHY.    1  vol.,  with  26  colored  plates,  hf.  bound. 
LARDNER'S  HANDBOOKS  OF  NATURAL  PHI 
LOSOPHY  AND  ASTRONOMY. 
FIRST  COURSE,  containing  Mechanics,  Hydrosta 
tics,  Hydraulics,  Pneumatics,  Sound,  and  Optics. 
1  very  large  vol.,  royal  12mo.,  sheep,  424  cuts. 
SECOND  COURSE,  containing  Heat,  Electricity,  Mag 
netism,  and  Galvanism.  1  vol.  royal  12mo., sheep, 
250  cuts. 

THIRD  COURSE,  containing  Astronomy  and  Meteo 
rology.  1  very  large  vol.,  royal  12mo.,  37  plates 
and  216  wood-cuts.     (Now  ready.) 
MULLER'S  PHYSICS  AND  METEOROLOGY.  1 
vol.  8vo.,  over  500  beautiful  cuts  and  two  colored 
plates,  extra  cloth. 

NATIONAL  SCHOOL  MANUAL.    4  parts.   12mo. 
SOMERVILLE  S  PHYSICAL   GEOGRAPHY.    3d 
and  enlarged  edition,  witn  American  notes.   1  large 
vol.  royal  12mo..  extra  cloth. 

SHAW'S   OUTLINES    OF    ENGLISH    LITERA 
TURE.    2d  ed.    AVith  Sketch  of  American  Litera 
ture.    By  TUCKKRMAX.     1  vol.  royal  I2rno.,  ext  cl. 
SCHOEDLER  AND  MEDLOCK'S  BOOK  OF  NA 
TURE.     Edited  and  revised.    1  large  vol.,  crown 
Svo.,  with  679  wood  cuts.     (Now  read}-.) 
SCHMITZ  AND  ZUMPT'S  CLASSICAL  SERIES 
FOR  SCHOOLS.    In  neat  royal  ISmo.  volumes,  as 
follows  : — 
KALTSCHMIDT'S    LATIN     DICTIONARY. 

Complete, handsome  embossed  leather. 
SCHMITZ'S  ELEMENTARY  LATIN  GRAM 
MAR  AND  EXERCISES. 

SCHMITZ'S  ADVANCED  LATIN  GRAMMAR. 
ADVANCED  LATIN  EXERCISE  BOOK,  with 

Selections  for  Reading.    (Now  Ready.) 
CJESAR,  extra  cloth,  with  a  Map. 
SALLUST.  extra  cloth,  with  a  Map. 
VIRGIL,  extra  cloth. 
OVID,  extra  cloth. 
HORACE,  extra  cloth. 
LIVY.  extra  cloth,  two  colored  Maps. 
CICERO,  extra  cloth. 

QUINTUS  CURTIUS,  extra  cloth,  with  a  Map. 
CORNELIUS  NEPOS,  now  ready,  extra  cloth. 

OTHER  WORKS  OF  THE  SERIES  PREPARING. 


ILLUSTRATED  MEDICAL  CATALOGUE, 

BLANCHAHD  &  LEA  have  now  ready  a  Catalogue  of  their  Medical,  Surgical,  and  Scien 
tific  Publications,  containing  descriptions  of  the  works,  with  Notices  of  the  Press,  and 
specimens  of  the  Illustrations,  making  a  pamphlet  of  sixty-four  large  octavo  pages.  It  has 
been  prepared  with  great  care,  and  without  regard  to  expense,  forming  one  of  the  most  beau 
tiful  specimens  of  typographical  execution  as  yet  issued  in  this  country.  Copies  will  be 
sent  by  mail,  and  the  postage  paid,  on  application  to  the  Publishers,  by  inclosing  two  three 
cent  postage  stamps. 


'hotomount 
pamphlet 
Binder 

lord  Bros.,  Inc 

Makers 
>ckton,  Calif 
"MAN.  21.  ,908  ' 


